Table 4 Examples of the category opinion on “Information transfer mechanisms”

1. Referral and counter-referral forms

“… We don’t have a counter-referral, we don’t know what occurred between [the specialist] and the patient, unless the patient tells us…” (Primary care level professional, Network 1 Brazil)

“In general they become involved in the bureaucratic function of the paper [the referral form] and very little is written down. Even when they have the paper available, many times there is very little information about the patient’s history… they don’t explain why the patients are being referred to the specialists or what has been done” (Provider manager, Network 1 Brazil)

“We have a referral system, the doctor refers [the patient], explains everything, all of it, but when the time comes to counter-refer the specialists never counter-refer” (Primary care level professional, Network 1-S Colombia)

“The counter-referral works for us with AIDS, chronic conditions and pregnancies, because the operation of the program implies an administrative component that supports the doctor in this, do I explain myself? (…) so for a high risk pregnancy, the perinatalogist conducts a lengthy consultation…has a nurse to give admin support and they have a unified system that means that they don’t have to copy the same [information] three times…” (Insurance manager, Network 2-S, Colombia)

2. Hospital discharge report

“when the patient is hospitalized and leaves we always give him a copy of the discharge report, that is to say that the patient leaves with a copy of what he’s had done, (…)” (Secondary care professional, Network 4-C Colombia)

“We do use the hospital discharge report. When a patient is discharged the doctor prepares a summary of the problem and what procedures were performed. It’s a way for the professional in primary care to follow-up the patient.” (Secondary care professional, Network 3 Brazil)

“they are generally poorly filled out [the discharge report]” (Primary care level professional, Network 1 Brazil)

“there is always a discharge report if the doctor is resident, when the hospital has a resident doctor, because if it doesn’t…” (Primary care level professional, Network 1 Brazil)

“What we do fill out is the hospital admission form, make a summary of the clinical record, but in many cases the outpatient care management plan isn’t specified” (Secondary care professional, Network 3-C Colombia)

3. Shared electronic clinical record

“We do know what happens to the patient, because the patient continues in the system despite going to endocrinology…We use the same system, so we can consult the record of the sub-specialist, the specialist in the majority of cases, so we can see what the cardiologist said, what the endocrinologist said, what the neurologist said” (Primary care professional, Network 3-C Colombia)

“the quality of the clinical record is poor in general, right? There may be other good things to be said about it, but in general the quality of the clinical record is poor. The tool is good and it could be improved, but the quality is poor. The quality of the record, what professionals include there” (Primary care level professional, Network 4-C Colombia)

“one of the problems we have had is that the clinical records of the specialists are mostly incomplete compared to those of the paediatricians and general physicians” (Provider manager, Network 3-C Colombia)

4. Problems with patient care due to lack of information transfer between levels

“There are other things one doesn’t know…if it was a test for two or three months to see if it would work or not; or if the dosage was supposed to get progressively higher or lower. Many times the specialist does explain this to the patient, but you could say that there are patients who don’t understand the information very well, so you ask and since they are not given written information, you end up getting a bit lost” (Primary care professional, Network 4 Colombia)

“if he [the primary care doctor] doesn’t give anything back to me then I won’t know if he investigated because the patient doesn’t know whether the doctor investigated or not(…) So I won’t know and now what? I start again from zero. This creates problems, one gets trapped this way because I don’t know what I am going to do next or what was done or what I have to do now” (Primary care professional, Network 3 Brazil)

“it holds things up,… it reverts back to basic care, they [the patients] should arrive with a clinical record saying what they have so you can follow-up after that point. No!, when he [the patient] arrives he starts over at zero, you have to begin as though it were basic care (…) So it’s the patient who is most hurt by this process, because he wastes time trying to get exams done that he should have brought with him” (Secondary care professional, Network 3 Brazil)

“not having a shared clinical record affects us…many times exams are repeated unnecessarily, because in one institution they don’t know of all the exams carried out on a patient in another institution” (Insurance manager, Network 1-S Colombia)