Clinical coordination between primary-level physicians and referral-level specialists in Morocco: a cross-sectional...

Area of Science:

• Healthcare Management
• Clinical Coordination
• Physician Collaboration

Background:

• Clinical coordination between primary level physicians (PLP) and referral level specialists (RLS) is vital for healthcare system overhauls, yet under-documented in North Africa.
• This study addresses the need to assess clinical coordination in Morocco's Casablanca-Settat region and identify key influencing factors.

Purpose of the Study:

• To evaluate the current state of clinical coordination between PLP and RLS in the Casablanca-Settat region.
• To identify sociodemographic, organizational, and interactional factors associated with physicians' perceptions of clinical coordination.

Main Methods:

• An analytical cross-sectional survey utilized the validated COORDENA-CAT questionnaire among 329 physicians (186 PLP, 143 RLS).
• Data collected included experiences of information-sharing, clinical-management coordination, and perceptions of overall coordination.
• Multivariable logistic regression analysis identified factors associated with a high perception of coordination.

Main Results:

• Only 30.7% of physicians reported regular clinical information sharing, with limited therapeutic coherence (24.3% jointly defined care plans).
• Physician agreement on referral appropriateness was low (97.3% PLP vs. 59.4% RLS).
• Independent factors for high coordination perception included working at the referral level, personal ties, perceived mutual influence, and supportive institutional environments.

Conclusions:

• Clinical coordination is significantly limited, particularly for PLP, due to insufficient feedback, weak formal structures, and restricted specialist access.
• Priority strategies include strengthening local governance, implementing secure digital tools (EHR, tele-expertise), regular clinical meetings, and formalizing PLP roles as care coordinators.