PATIENTS, GENERAL PRACTITIONERS AND HOSPITAL SPECIALISTS’ PERSPECTIVES ON COLLABORATION BETWEEN PRIMARY AND SECONDARY CARE.

Poor collaboration between professionals can adversely affect the delivery of health services and patient care, particularly in cases of chronic illness. Collaboration between general practitioners (GPs) and specialists has been the focus of many care projects during the past decade at international level. However, barriers to the integration of care such as structure, procedures, legitimacy at system level as well as the professional self-interest at the operational level, can negatively influence the collaboration between setting of care. The main aim of the paper is to analyse the perceptions concerning the collaboration between professionals of primary and secondary care and its possible facilitating factors, by exploring and comparing the perspectives of patients, GPs, and hospital specialists (HSs) with a set of mirror questions using three different survey in Tuscany Region in 2015. Facilitating factors are consider mainly processual variable such as regular meetings, working in the same facilities and sharing data with information system. All three survey used structured questionnaires that included items and scales measuring experience, satisfaction and expectations. In terms of results, patients are more satisfied comparing with professionals: they perceived a good collaboration between primary and secondary care (3.35/5); while GPs and HSs are less enthusiastic. Considering the facilitating factors, professionals prefer working in the same facilities, following by sharing data and information system and regulars meetings, while patients mainly prefer meetings as possible facilitating tools for a good collaboration. We discuss the results using a “gradient of proximity” of the three conditions: working in the same building refers to a forced physical proximity, but not necessary interactions; regular meetings consider a forced interaction but not necessary a continuous level of proximity or a formal co-location of professionals. The information system does not necessarily requires physical presence neither interactions; it mainly refers to technical connection in terms of data and information. Our results support the fact that considering the expectations and perspective of involved actors in collaboration is a necessary condition for developing and implementing successful collaboration interventions.