Table 5 Examples of the category “Clinical management coordination mechanisms”

1. Benefits of the expert system

“There’s the Staff [specialist support groups] with their different specialties, we in the ambulatory care centre have Gynaecology, Paediatrics, Psychology, Orthopaedics, Internal Medicine and… that’s all the Staff we have. In each meeting we review cases and the specialists help us to resolve the cases” (Primary care professional, Network 4-C)

“The question of the “matriciamento” [expert system], is what I was telling you about, the question of maintaining this communication with the secondary care network, tertiary care, and managing to resolve cases that primary care can’t resolve in an effective way, understand? Because the patient comes back to you and you conclude his treatment here, but now with the specialist’s opinion; I think that helps to resolve cases” (Primary care professional, Network 1 Brazil).

2. Problems with the expert system

“the time we have to interact is really very little, that’s why I say that this space here, one hour a month is very important, but it’s not enough” (Primary care professional, Network 4-C)

“this is done only once a month [expert system],” because people can’t do any more, because every time you hold a meeting you take teams from the unit, someone is not providing care, it is very difficult to do (Provider manager Network 1 Brazil)

3. Low adherence to the CPG

“(…) the dynamics of the rotation of professionals influences the level of adherence to the guidelines and protocols. When we evaluate we find everything, professionals who stick closely to the guidelines and, more often than not, others who don’t, but it all comes down to the constant changes of personnel” (Provider manager, Network 2-S Colombia)

“The hospitals do not adhere to the guidelines, we proved this in the last network committee, about a maternal death in a third level hospital, the guidelines themselves were not taken into account for the care of the patient, it’s a lack of adherence to guidelines” (Administrative insurance professional, Network 2-S Colombia)