Table 5 Doctors’ opinion on factors influencing the use of available care coordination mechanisms in the studied healthcare networks

Organizational factors

A1) Insufficient time to use mechanisms

“Lack of time is what mainly…Of course, you’ve got your job, and this should also form part of the job, shouldn’t it? Being able to do things to help so there’s more communication and more coordination, which we already try to do, you know? But basically I think that (the problem) is lack of time or that this time isn’t included in our working hours, our contracted hours, you know?” (secondary care doctor, Baix Empordà)

A2) Incompatibility of timetables to participate in joint clinical sessions

“Sometimes it’s due to problems that primary care doctors have, because they don’t finish at two, they finish later and don’t have time to get there, and those that start later, at three, well sometimes they can’t get there beforehand to give us time (…) if they can’t find the time to go sometimes it’d be more practical to just refer the patient (…). And then of course the specialists already knew that they tended not to turn up, so normally they would also leave at, when they finished at two, so in the end, between one thing and another the face-to-face consults weren’t very practical” (secondary care doctor, Barcelona)

A3) Design of mechanisms: EMR

“There are a lot of duplicated diagnoses. You’ve got a patient, you send them to emergencies and you send them with a generic diagnosis, maybe “stomach pains”, and maybe it’s appendicitis, for example. The one who sees them in emergencies, and the one who operates on them, doesn’t change the diagnosis and adds a new one instead. And so, when you want to put the medical record in order and you want to drag across the processes to put them all into one and link them with an X-ray, well (the EMR) won’t let you do it because (the episode) is closed. (…) I think that a lot has been implemented but the same old problems haven’t been solved.” (primary care doctor, Baix Empordà)

A4) Design of mechanisms: clinical case conferences

“Well, I suppose that as there’s no real contact (by videoconference), they don’t resolve as many issues. (…) the truth is that I don’t comment on any of them (via videoconferencing). I’d rather they saw the patient, instead of commenting on the plates (image testing results) by videoconference.” (primary care doctor, Girona)

Professional factors

B1) Attitude and interest in collaborating with the other level

“Right, so, I need to request another analysis to check a, a renal function, yeah? [they can consult and modify test requests through the medical record] And these specialists don’t look at it, they don’t look at it because there are filters. Because in the medical record I can, firstly I can filter it and I can remove all the information that isn’t mine. And that’s what the specialists do. I mean, we’ve got a computerised medical record but they tick the filter and they only look at their own medical history and they don’t look, they don’t look at anything else. They’re not interested, right?” (primary care doctor, Baix Empordà)

B2) Knowing each other

“In any case, the good thing I was telling you about is that as they’re normally very accessible, and we have a good relationship with everyone, well sometimes we can ask, or have an informal consultation with this person, with this specialist in particular, to talk about the patient and sort some things out, for example” (primary care doctor, Barcelona)

B3) Lack of awareness of how the mechanisms work

“We designed a rapid pathway for cancer (…). A way, a pathway to say when (they should use it), (…) I also did a session for them, I explained the criteria to them (…), and they carry on sending people via the rapid diagnostic circuit without them fulfilling any of these criteria. I mean, there may be an urgent test required, yeah? I’m not saying there isn’t, but it doesn’t fulfil the criteria to use this pathway” (secondary care doctor, Barcelona)

B4) Concerns over making diagnosis without physical presence of patient

“And the fear is this (on participating in clinical case conferences), that some day there may be something that has to wait and then is made to wait too long, or that the details are lost (…) or (there’s some problem with) transmitting the information” (primary care doctor, Girona).