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Background A community of clinical practice called the Online Communication Tool between Primary and Hospital Care (ECOPIH) was created to enable primary care and specialist care professionals to communicate with each other in order to resolve real clinical cases, thereby improving communication and coordination between care levels. The present work seeks to analyse whether ECOPIH makes it possible to reduce the number of referrals. To that end, the objectives are: (1) To find out the degree of loyalty among ECOPIH users, by comparing the medical professionals’ profiles in the tool’s implementation phase to those in its consolidation phase. (2) To evaluate the degree of fulfilment of users’ expectations, by establishing the determining factors that had an influence on the physicians’ intention to use ECOPIH in the implementation phase and observing whether its use had an effective, direct impact on the number of patient referrals that primary care physicians made to specialist care professionals. Methods Two studies were conducted. Based on a survey of all the physicians in a Primary Care area, Study 1 was a descriptive study in ECOPIH’s implementation phase. Study 2 was a randomised intervention study of ECOPIH users in the tool’s consolidation phase. The results from both studies were compared. Various bivariate and multivariate statistical techniques (exploratory factor analysis, cluster analysis, logistic regression analysis and ANOVA) were used in both studies, which were conducted on a sample of 111 and 178 physicians, respectively. Results We confirmed the existence of an ECOPIH user profile stable across both phases: under-50-year-old women. Regarding the second objective, there were two particular findings. First, the discriminant factors that had an influence on greater ECOPIH use were habitual Social media website and app use and Perceived usefulness for reducing costs. Second, PC professionals who were ECOPIH members made fewer referrals to SC professionals in Cardiology, Endocrinology and Gastroenterology than older PC professionals who were not ECOPIH members. Conclusions The use of a community of clinical practice by primary care and specialist care professionals helps to reduce the number of referrals among medical professionals.

Objective: to understand how repercussions of the referral and counter-referral of patients with indication/submitted to Coronary Artery Bypass Graft Surgery in the context of Primary Health Care. Method: qualitative research with a theoretical-methodological contribution anchored in the Grounded Theory. Theoretical sampling was performed with 41 participants, divided into three sample groups (patients, health professionals and managers) in the Metropolitan Region and Western Region of Santa Catarina State. Results: the need for improvement in the process of recording clinical data in the regulation system emerged to strengthen patient referral; and the absence of a formal process of counter-referral and adaptation of lifestyle with repercussion in the counter-referral. Final considerations: the repercussions of the referral and counter-referral of patients with indication/submitted to the CABGS in the context of Primary Care are experienced through professional guidance and, in particular, by family support. RESUMEN Objetivo: comprender cómo son vivenciadas las repercusiones del proceso de referencia y contrarreferencia del paciente con indicación o sometido a la Cirugía de Revascularización Miocárdica en la Atención Primaria a la Salud. Método: investigación cualitativa con aporte teórico-metodológico anclado en la Teoría Fundamentada en los Datos. Se alcanzó el muestreo teórico con 41 participantes, divididos en tres grupos muestrales (pacientes, profesionales de salud y gestores) en la Región Metropolitana y Región Oeste de Santa Catarina. Resultados: surgió la necesidad de mejora en el proceso de registro de los datos clínicos en el sistema de regulación para fortalecer la referencia del paciente; y ausencia de un proceso formal de contrarreferencia y adaptación del estilo de vida con repercusión en la contrarreferencia. Consideraciones finales: las repercusiones del proceso de referencia y la contrarreferencia del paciente con indicación o sometido a la CRM en el contexto de la atención primaria son vivenciadas por medio de las orientaciones profesionales y, en especial, por el apoyo de la familia. RESUMO Objetivo: compreender como são vivenciadas as repercussões do processo de referência e contrarreferência do paciente com indicação/submetido à Cirurgia de Revascularização Miocárdica na Atenção Primária à Saúde. Método: pesquisa qualitativa com aporte teórico-metodológico ancorado na Teoria Fundamentada nos Dados. Alcançou-se a amostragem teórica com 41 participantes, divididos em três grupos amostrais (pacientes, profissionais de saúde e gestores) na Região Metropolitana e Região Oeste de Santa Catarina. Resultados: emergiu a necessidade de melhoria no processo de registro dos dados clínicos no sistema de regulação para fortalecimento da referência do paciente; e ausência de um processo formal de contrarreferência e adaptação do estilo de vida com repercussão na contrarreferência. Considerações finais: as repercussões do processo de referência e contrarreferência do paciente com indicação/submetido à CRM no contexto da Atenção Primária são vivenciadas por meio das orientações profissionais e, em especial, pelo apoio da família.

Background The current reality of primary care (PC) makes it essential to have telemedicine systems available to facilitate communication between care levels. Communities of practice have great potential in terms of care and education, and that is why the Online Communication Tool between Primary and Hospital Care was created. This tool enables PC and non-GP specialist care (SC) professionals to raise clinical cases for consultation and to share information. The objective of this article is to explore healthcare professionals’ views on communities of clinical practice (CoCPs) and the changes that need to be made in an uncontrolled real-life setting after more than two years of use. Methods A descriptive-interpretative qualitative study was conducted on a total of 29 healthcare professionals who were users and non-users of a CoCP using 2 focus groups, 3 triangular groups and 5 individual interviews. There were 18 women, 21 physicians and 8 nurses. Of the interviewees, 21 were PC professionals, 24 were users of a CoCP and 7 held managerial positions. Results For a system of communication between PC and SC to become a tool that is habitually used and very useful, the interviewees considered that it would have to be able to find quick, effective solutions to the queries raised, based on up-to-date information that is directly applicable to daily clinical practice. Contact should be virtual – and probably collaborative – via a platform integrated into their habitual workstations and led by PC professionals. Organisational changes should be implemented to enable users to have more time in their working day to spend on the tool, and professionals should have a proactive attitude in order to make the most if its potential. It is also important to make certain technological changes, basically aimed at improving the tool’s accessibility, by integrating it into habitual clinical workstations. Conclusions The collaborative tool that provides reliable, up-to-date information that is highly transferrable to clinical practice is valued for its effectiveness, efficiency and educational capacity. In order to make the most of its potential in terms of care and education, organisational changes and techniques are required to foster greater use. Electronic supplementary material The online version of this article (10.1186/s12875-018-0739-0) contains supplementary material, which is available to authorized users.