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

As part of the ongoing overhaul of the Moroccan health-care system, clinical coordination between primary level physicians (PLP) and referral level specialists (RLS) remains crucial but under documented, especially in North Africa and the Eastern Mediterranean Region. This study aimed to assess clinical coordination levels in the Casablanca-Settat region and identify influencing factors.

An analytical cross-sectional survey was conducted from April to May 2024 among a random sample of 329 public-sector physicians (186 PLP; 143 RLS) from a pool of 1637 eligible practitioners. The COORDENA-CAT questionnaire, adapted from the original COORDENA instrument developed in Latin America and refined in Catalonia, was translated into French, culturally adapted, and psychometrically validated in four steps: forward-back translation, expert review, cognitive interviews, and a pilot study confirming construct validity and reliability. Fourteen items evaluated experiences of information-sharing and clinical-management coordination, whereas one summary item captured overall perception. Sociodemographic, organizational, and interactional data were collected. A multivariable logistic regression was performed to identify factors associated with a high perception of coordination (α = 0.05).

Only 30.7% respondents (18.8% of PLP vs. 46.2% of RLS) reported regularly sharing clinical information. Therapeutic coherence was limited, with just 24.3% stating that care plans were jointly defined. While 97.3% of the PLP considered referrals appropriate, only 59.4% of the RLS agreed. Overall, 27.7% of the physicians (17.2% PLP and 41.3% RLS) judged coordination "often or always" satisfactory. Independent determinants of a high perception of coordination included working at the referral level (adjusted OR (aOR) = 3.34; 95% CI: 1.60-6.97), having personal ties with the other level (aOR = 3.05; 1.54-6.04), perceiving mutual influence on practice (aOR = 2.39; 1.24-4.58), and working in an institution that facilitates coordination (aOR = 2.66; 1.37-5.17).

Clinical coordination in the study region is limited, especially among PLP, due to inadequate feedback, weak formal mechanisms, and restricted specialist access. Strengthening local governance, providing secure digital tools (such as shared electronic health record and tele-expertise), organizing regular clinical meetings, and granting PLP formal recognition as care coordinators are priority strategies to enhance the continuity and efficiency of care pathways.