Background: Clinical coordination across care levels is a priority for health systems around the world, especially for those based on primary health care. The aim of this study is to analyse the degree of clinical information and clinical management coordination across healthcare levels in the Catalan national health system experienced by primary (PC) and secondary care (SC) doctors and explore the associated factors.Methods: Cross-sectional study based on an online survey using the self-administered questionnaire COORDENA-CAT. Data collection: October–December 2017. Study population: PC and SC (acute and long term) doctors of the Catalan national health system. Participation rate was 21%, with a sample of 3308 doctors. Outcome variables: cross-level clinical information coordination, clinical management coordination, and perception of cross-level coordination within the area. Explanatory variables: socio-demographic, employment characteristics, attitude towards job, type of area (according to type of hospital and management), interactional factors, organizational factors and knowledge of existing coordination mechanisms. Stratification variable: level of care. Descriptive and multivariate analysis by logistic regression.Results: The degree of clinical coordination experienced across levels of care was high for both PC and SC doctors, although PC doctors experienced greater exchange and use of information and SC doctors experienced greater consistency of care. However, only 32.13% of PC and 35.72% of SC doctors found that patient care was coordinated across care levels within their area. In both levels of care, knowing the doctors of the other level, working in an area where the same entity manages SC and majority of PC, and holding joint clinical case conferences were factors positively associated with perceiving high levels of clinical coordination. Other associated factors were specific to the care level, such as being informed of a patient’s discharge from hospital for PC doctors, or trusting in the clinical skills of the other care level for SC doctors.Conclusions: Interactional and organizational factors are positively associated with perceiving high levels of clinical coordination. Introducing policies to enhance such factors can foster clinical coordination between different health care levels. The COORDENA questionnaire allows us to identify fields for improvement in clinical coordination.

Clinical coordination between primary (PC) and secondary care (SC) is a challenge for health systems, and clinical coordination mechanisms (CCM) play an important role in the interface between care levels. It is therefore essential to understand the elements that may hinder their use. This study aims to analyze the level of use of CCM, the difficulties and factors associated with their use, and suggestions for improving clinical coordination. A cross-sectional online survey-based study using the questionnaire COORDENA-CAT was conducted with 3308 PC and SC doctors in the Catalan national health system. Descriptive bivariate analysis and logistic regression models were used. Shared Electronic Medical Records were the most frequently used CCM, especially by PC doctors, and the one that presented most difficulties in use, mostly related to technical problems. Some factors positively associated with frequent use of various CCM were: working full-time in integrated areas, or with local hospitals. Interactional and organizational factors contributed to a greater extent among SC doctors. Suggestions for improving clinical coordination were similar between care levels and related mainly to the improvement of CCM. In an era where management tools are shifting towards technology-based CCM, this study can help to design strategies to improve their effectiveness.

To analyze the experience and perception of clinical coordination across care levels and doctor's organizational and interactional related factors, according to the type of management integration of the healthcare services of the area, in Catalonia. Cross-sectional study based on an online survey by self-administration of the questionnaire COORDENA-CAT. October-December 2017. primary and secondary care (acute and long-term care) doctors of the public Catalan health system. 3308 doctors. experience and perception of clinical coordination, knowledge and use of coordination mechanisms and organizational and interactional factors; explanatory variables: area according to type of management (integrated, semi-integrated, non-integrated), socio-demographic, employment characteristics and attitude toward work. Descriptive analysis by type of area and multivariate analysis by robust Poisson regression. Better clinical coordination was observed in integrated areas compared to those semi-integrated, mainly in relation to information transfer, adequate follow-up and perception of coordination in the area. No differences were found between integrated and non-integrated areas in the clinical coordination experience, although there were differences in perception and some related factors. There are common problems across areas, such as accessibility to secondary care. Few differences were found between integrated and non-integrated areas, revealing that management integration may facilitate clinical coordination but is not enough. Differences with semi-integrated areas indicate the need to promote cooperation formulas between all the providers of the territory, with common objectives and coordination mechanisms, in order to avoid inequalities in quality of care.

Background Studying the working population’s mental health in times of crisis (such as the 2008 recession or the COVID-19 pandemic) is very relevant. This study aims to assess the prevalence of poor mental health among the Spanish salaried population, according to the labour market inequality axes (2005–2021). Methods Repeated cross-sectional study by comparing different surveys from 2005, 2010, 2016 and 2021 on workers residing in Spain who had been working in a salaried job during the week preceding the survey. n=7197 (2005), n=4985 (2010), n=1807 (2016) and n=18 870 (2021). Outcome variable: poor mental health (Mental Health Inventory of the 36-item Short Form Health Survey scale). Explanatory variables: gender, age, occupational class and type of contract. Prevalence of poor mental health was estimated for each year by means of logistic regression models with robust clustered SEs, stratifying by the explanatory variables. Additionally, prevalence ratios (PR) were estimated by means of robust Poisson regression models to assess differences between the explanatory variables’ categories. All analyses were weighted to address unrepresentativeness. Results Poor mental health significantly increased in 2021 (55.92%), compared with the previous years of study (15%–17.72%). Additionally, pattern changes were identified on inequality axes in 2021, with better mental health status among older workers (oldest group PR: 0.76; 95% CI 0.71 to 0.8) and permanent workers (PR: 0.9; 95% CI 0.85 to 0.94). Conclusion This study shows a steep worsening of mental health among the salaried population in 2021 compared with previous periods. In 2021, health inequalities have apparently narrowed, although not by improving the disadvantaged groups’ mental health but by worsening the typically advantaged groups’ mental health.

Objective: The aim of the study is to test the relationship between different conceptualizations of job insecurity and health over time by applying a longitudinal design. Methods: 543 workers were reinterviewed after 1 year to check if being exposed to job insecurity affected their general and mental health. Robust Poisson regressions were fitted to calculate the incidence rate ratio between job insecurities and two health outcomes. Results: Cognitive job loss insecurity increases the risk of poor mental and general health. Other expressions of job insecurity such as labor market insecurity and working conditions insecurity, as well as affective job insecurity, are not significantly related to health across time. Conclusions: Caution is needed when interpreting cross-sectional results. Protection against the threat of losing a job would prevent mental health issues and poor general health.

Los riesgos psicosociales configuran uno de los aspectos más relevantes del ambiente de trabajo en relación con la salud, y con la salud mental en particular. Existe abundante evidencia en relación con el efecto que tiene la exposición a diversos de estos riesgos sobre la incidencia de episodios de depresión, burnout, trastornos ansiosodepresivos, problemas del sueño e incluso en la ideación suicida. La salud mental entre la población trabajadora en España se ha mantenido relativamente estable de 2005 a 2016 con un deterioro muy importante en 2021 con la irrupción de la COVID-19. Así, en 2021 más de la mitad de los/las trabajadores/as estaban a riesgo de padecer algún trastorno moderado ansiosodepresivo (55,9 %), cifra que triplicaba la de 2016, mientras que el 18,9 % estaban a riesgo de trastornos severos, más de nueve veces lo estimado cinco años atrás. De forma similar, la exposición a riesgos psicosociales se ha incrementado de forma abrupta, siendo que los trabajos demandantes emocionalmente e ítems relacionados con el conflicto trabajo-familia muestran patrones de exposición similares a los de la salud mental.