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The COVID-19 pandemic and the measures adopted are having a profound impact on a major goal of public healthcare systems: universal access to health services. The objective is to synthesize the available knowledge on access to health care for non-COVID-19 conditions and to identify knowledge gaps. A scoping review was conducted searching different databases (Medline, Google Scholar, etc.) for original articles published between December 2019 and September 2021. A total of 53 articles were selected and analyzed using the Aday and Andersen framework as a guide. Of these, 37 analyzed changes in levels of use of health services, 15 focused on the influencing factors and barriers to access, and 1 studied both aspects. Most focused on specific diseases and the early stages of the pandemic, based on a review of records. Analyses of the impact on primary care services’ use, unmet needs or inequalities in access were scarce. A generalized reduction in the use of health services was described. The most frequent access barrier described for non-COVID-19 conditions related to the services was a lack of resources, while barriers related to the population were predisposing (fear of contagion, stigma, or anticipating barriers) and enabling characteristics (worse socioeconomic status and an increase in technological barriers). In conclusion, our results show a general reduction in services’ use in the early stages of the pandemic, as well as new barriers to access and the exacerbation of existing ones. In view of these results, more studies are required on the subsequent stages of the pandemic, to shed more light on the factors that have influenced access and the pandemic’s impact on equity of access.

Objetivo Analizar las estrategias para la mejora de la coordinación clínica propuestas por medicos/as de atención primaria (AP) y especializada (AE) de redes públicas de servicios de salud de seis países de América Latina, y sus cambios entre el 2015 y 2017. Métodos Se analizaron dos estudios transversales basados en encuestas (2015 y 2017) con aplicación del cuestionario COORDENA a un total de 4 311 médicos/as de atención primaria y especializada de dos redes públicas de servicios de salud de cada país. Se realizó un análisis descriptivo estratificado por país y año de las sugerencias propuestas. Resultados En todos los países se señala la introducción o mejora de estrategias y mecanismos que facilitan la interacción y el conocimiento mutuo entre profesionales de distintos niveles, especialmente las reuniones conjuntas internivel, los mecanismos de comunicación directa y estrategias para fortalecer el uso de la hoja de referencia y contrarreferencia. Con menor frecuencia, se sugieren otras estrategias organizativas orientadas al fortalecimiento del modelo de atención primaria, la mejora del acceso a atención especializada y la coordinación del nivel directivo de la red. Conclusiones Los resultados permiten generar recomendaciones para la mejora de la coordinación clínica en distintos sistemas de salud, a partir de las sugerencias de los médicos/as, una perspectiva poco tenida en cuenta en el diseño e implementación de intervenciones en los servicios de salud. Se señala la necesidad de promover estrategias basadas en la retroalimentación mutua en la elaboración de políticas públicas sanitarias. Objective To analyze the strategies for improving clinical coordination proposed by primary care (PC) and secondary care (SC) doctors from the public healthcare networks in six Latin American countries, and the changes between 2015 and 2017. Methods Two cross-sectional studies based on surveys (2015 and 2017) were developed with the application of the COORDENA questionnaire to a total of 4 311 primary and secondary care doctors from two public healthcare networks in each country. A descriptive analysis of the proposed suggestions was carried out stratified by country and year. Results In all countries, the introduction or improvement of strategies and mechanisms that ease interaction and mutual knowledge between professionals from different care levels is noted, especially joint cross-level meetings, direct communication mechanisms and strategies to strengthen the use of the referral and back-referral form. Less frequently, other organisational strategies are suggested aimed at strengthening the primary care model, access to secondary care and the coordination of the network'smanagement. Conclusions The results allow to generate recommendations for the improvement of clinical coordination in different health systems drawn from the suggestions made by doctors, a perspective that is seldom considered in the design and implementation of interventions in healthcare services. The need to promote strategies based on mutual adjustment in the development of public health policies is highlighted.