To the Editor,
Coordination between levels of care is essential if we are to achieve more efficient health care. Lack of coordination can arise through lack of knowledge, poor communication, a dearth of protocols, high burdens of care, and other systematic barriers.
The integrated care model in cardiology1 transformed the traditional system with its 3 separate levels of care into an integrative model in which a hospital cardiologist works as part of a primary care team. Although we used information and communication technologies, shared medical records, and a computing platform for the transmission of information, above all we encouraged personal contact between professionals. Consulting sessions, the possibility of immediate consultation by phone or e-mail, and the development of agreed clinical guidelines were essential to improving coordination.
The aim was not to reduce later visits, but to improve patient care through integration. The primary care team took the lead role in controlling stable chronic patients while the cardiologist acted as a consultant and focused on assessing new disease and monitoring patients who required closer control.
We do not agree that the responsibility for health rests solely with the family physician and the citizen. The multidisciplinary element in the integrative approach means that responsibilities are shared between the primary care team and cardiologists.2 By organizing, distributing, and influencing resources, managers, public administrators, and scientific societies also have a share of the responsibility.
While information technology and communication play an important part in integrated health care, they are only tools to help health care professionals. Technological advances are not always accompanied by demonstrable benefits for patients.3 Although it is reasonable to assume that e-Health is useful, its impact must be demonstrated objectively.
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Corresponding author: cfalces@clinic.ub.es