Fortalecimiento del recurso humano para la atención de personas con enfermedades crónicas / Strengthening Human Resources for Providing Care to People with Chronic Diseases

Introducción: Las enfermedades crónicas implican un reto sanitario e intersectorial. Por ello, los prestadores requieren adquirir competencias específicas según estándares nacionales e internacionales para implantar una atención primaria de salud que provea acceso y cobertura universal. Objetivo: Reflexionar sobre elementos relevantes vinculados a las competencias de los proveedores de salud para la atención de personas con condiciones crónicas, en el contexto de la atención primaria de salud. Métodos: Se discuten estrategias, la implementación del Modelo de Cuidados Crónicos y la adquisición de competencias, analizando aspectos de la formación profesional, el aseguramiento de la educación continua y la disposición de los proveedores para estar a la vanguardia de los cuidados. Conclusiones: Para proveer una atención integral a personas con enfermedades crónicas es necesario el fortalecimiento del capital humano y la instalación de relaciones coproductivas entre el equipo multidisciplinario. Además, es fundamental que los equipos conozcan e incorporen estrategias con demostración de eficacia a nivel internacional, entre ellos se encuentra el Modelo de Cuidados Crónicos, cuya implementación ha sido lenta y con desarrollo parcial(AU)

Introduction: Chronic diseases represent a health and intersectoral challenge. Therefore, providers need to acquire specific competences according to national and international standards, in order to implement primary healthcare providing universal access and coverage. Objective: To reflect on the relevant elements related to the competences of healthcare providers for the care of people with chronic conditions in the context of primary healthcare. Methods: Strategies are discussed, together with the implementation of the chronic care model and the acquisition of competences, analyzing aspects of professional training, the assurance of continuing education and the willingness of providers to be at the forefront of care. Conclusions: In order to provide comprehensive care to people with chronic diseases, it is necessary to strengthen human capital and create coproductive relationships among the multidisciplinary team. In addition, it is essential that the teams be aware of and incorporate strategies that have been shown to be effective at the international level, including the chronic care model, whose implementation has been slow and only partially developed(AU)

Caracterización del programa de salud cardiovascular GES DM2 e HTA bajo un modelo de intervenciones múltiples en una Unidad de Salud Familiar (UMF) de un centro médico privado / Characterization of a cardiovascular health program in Type 2 Diabetes Mellitus and Arterial Hypertension, under a model of multiple interventions in a Family Medicine Health Unit, of a private medical center

In the Family Medicine Unit (UMF) of the UC Health Network there is a program of multiple interventions based on a Chronic Control Model (CCM), led by a nurse who coordinates the activities and ensures compliance, aspiring to a change in its model of care and self-sustainability. It has been running for several years and its implementation and results have not been evaluated. Objective: This study aims to describe the situation of the Program, at its different levels: structure, processes and results. Material and method: Observational, descriptive longitudinal study of patients seen between July 2010 and June 2012, based on: methodology proposed by A. Donabedian; E. Wagner recommendations for the MTC; Monthly Statistical Registers and recommendations of the GES DM2 and HTA (MINSAL) Guides. Results: Hypertensive patients present a reduction of 11.2 mmHg in SBP and 7.8 mmHg in DBP (p 0.04). Diabetics present a reduction in HbA1c by 1.5 percentage points (p 0.04), and mixed patients present a SBP / DBP reduction of 10.3 and 6.8 mmHg respectively and an HbA1c reduction of 1.1 percentage points (p 0.092). Conclusions: After an average of 15 months, hypertensive patients significantly improve their mean SBP, DBP and compensation percentages; diabetics significantly improve their mean HbA1c and compensation percentages; mixed patients manage to improve their blood pressure and HbA1c levels, but this is not statistically significant.

Patient Assessment of Chronic Illness Care (PACIC) of diabetes in the out-patient department of a private hospital

Background@#Patient-centered outcomes in chronic care assessed through Quality of Health Care can be measured by its congruence to the Chronic Care Model (CCM) using Patient Assessment of Chronic Illness Care (PACIC). Behavioral and quality measures that influence the patient’s perception of the quality of care remain unknown.@*Objective@#This study aimed to assess the quality of chronic illness care among diabetic patients using PACIC and its relationship to socio-demographic factors.@*Methods@#A cross-sectional study involving diabetic patients of the Out-Patient Department of a private hospital were enrolled through non-probability sampling. Overall score from the PACIC questionnaire, its subscale scores and its relationship with the socio-demographic factors were determined using descriptive statistics.@*Results@#All participants were married and living with their families. Median age was 58. The over- all PACIC score was 3.53 + 0.72 SD. Problem solving/Contextual subscale presented the highest score while follow up/coordination had the least. Those who have college degrees had significantly lower mean scores than high school graduates (p-value = 0.032).@*Conclusion@#PACIC scores indicate a moderate to high quality of care. PACIC is a practical instrument that can be used in quality assessment and improvement programs.

Validity and reliability of the Patient Assessment on Chronic Illness Care (PACIC) questionnaire among patients with type 2 diabetes mellitus in Malaysia: English version

@#Introduction: The Patient Assessment on Chronic Illness Care (PACIC) was developed to assess patients’ perspectives on the alignment of primary care to the chronic care model. The Malay PACIC has been validated; however, Malaysia is a multicultural society, and English is spoken by many Malaysians and expatriates. We sought to validate the English version of the PACIC among patients with diabetes mellitus in Malaysia, as Malaysians may interpret a questionnaire that was originally developed for Americans in a different way. Method: This study was conducted between November and December 2016 at two primary care clinics that offered integrated diabetes care at the time. These sites were selected to assess the discriminative validity of the PACIC. Site 1 is a Malaysian Ministry of Health-run primary care clinic while site 2 is a university-run hospital-based primary care clinic. Only site 1 annually monitors patient performance and encourages them to achieve their HbA1c targets using a standard checklist. Patients with diabetes mellitus who understood English were recruited. Participants were asked to fill out the PACIC at baseline and two weeks later. Results: A total of 200 out of the 212 invited agreed to participate (response rate=94.3%). Confirmatory factor analysis confirmed the 5-factor structure of the PACIC. The overall PACIC score and the score in two of the five domains were significantly higher at site 1 than at site 2. The overall Cronbach’s alpha was 0.924. At test-retest, intra-class correlation coefficient values ranged from 0.641 to 0.882. Conclusion: The English version of the PACIC was found to be a valid and reliable instrument to assess the quality of care among patients with diabetes mellitus in Malaysia.

Feasibility of Implementing Chronic Care Model in the Malaysian Public Primary Care Setting

Introduction: Non-communicable diseases (NCD) is a global health threat. the Chronic Care Model (CCM) was proven effective in improving NCD management and outcomes in developed countries. Evidence from developing countries including Malaysia is limited and feasibility of CCM implementation has not been assessed. this study intends to assess the feasibility of public primary health care clinics (PHC) in providing care according to the CCM. Methodology: A cross-sectional survey was conducted to assess the public PHC ability to implement the components of CCM. All public PHC with Family Medicine Specialist in Selangor and Kuala Lumpur were invited to participate. A site feasibility questionnaire was distributed to collect site investigator and clinic information as well as delivery of care for diabetes and hypertension. results: there were a total of 34 public PHC invited to participate with a response rate of 100%. there were 20 urban and 14 suburban clinics. the average number of patients seen per day ranged between 250-1000 patients. the clinic has a good mix of multidisciplinary team members. All clinics had a diabetic registry and 73.5% had a hypertensive registry. 23.5% had a dedicated diabetes and 26.5% had a dedicated hypertension clinic with most clinic implementing integrated care of acute and NCD cases. Discussion: the implementation of the essential components of CCM is feasible in public PHCs, despite various constraints. Although variations in delivery of care exists, majority of the clinics have adequate staff that were willing to be trained and are committed to improving patient care.

Diabetes care in the Philippines / Journal of the ASEAN Federation of Endocrine Societies

@#The global burden of diabetes and its accompanying risk factors is upon us. Asia is the focus of this burden, owing to huge population numbers and increasing prevalence rates. The Philippines National Health and Nutrition Survey (NNHeS) of 2013, has provided the latest health and disease score with prevalence rates of the major risk factors among adults >20 years of age: diabetes (5.4%), hypertension (22.3%), dyslipidemia, low HDL (71.3%), obesity, BMI >25 kg/m2 (31.1%), and smoking (25.4%). Metabolic syndrome as of the 2008 survey reports a 27% prevalence rate (unpublished data). Efforts have to be directed to achieve improvement in prevention, survival, and quality of life for all diabetics. The health infrastructure under the leadership of the Department of Health, in partnership with governmental and non-governmental organizations has to provide a cohesive plan engaging all partners in various aspects of care. Strategies to enhance outcomes include: 1) a national screening program, 2) implementation of practice guidelines that will elevate the quality of care for all, 3) access to healthcare, medications, 4) development of an environment for research in institutions to allow a better understanding of these conditions among Filipino patients and 5) enhancement of training, education and service to benefit the Filipino diabetic. Indeed, the challenge is upon all of us as a nation, and we need to stand up and move forward with an organized and accessible system of care, as we aim to combat the epidemic of diabetes and its complications.

Strategy for noncommunicable disease control and prevention

The prevalence of non-communicable disease (NCD) has been continuously increasing due to population ageing and changes in consumption and lifestyle patterns. This global trend is also apparent in the Republic of Korea, reflected in increasing mortality and personal costs for the treatment and management of NCD. Cancers, cerebrovascular diseases, and hypertensive diseases have been the major causes of death in South Korea since 1983. Numerous studies have suggested the need for a sustained comprehensive treatment tailored for individual patients and have recommend the development of a systematic program to manage NCD patients to provide such care. The Korean government has been implementing national NCD management programs since 2000. In 2005, the management of major NCD including hypertension, diabetes, heart disease, and stroke was included as a major target in the New Health Plan 2010. In 2006, the government established the National Cerebro-Vascular Disease Prevention and Control Policy, and a registry program for the group at high-risk for cardio-vascular disease (hypertension and diabetes) was implemented in 19 cities and counties from 2007, with gradual expansion over time. Recently, in line with the discussions on the reorientation of the health care delivery system movement, the government is to introduce a "clinic-centered NCD management policy" in 2012, which will strengthen the role of primary care clinics as sources of outpatient care for NCD, and will encourage patients to designate a primary care clinic of their choice for their continued care. The WHO global action plan guiding national-level NCD policies requires an NCD prevention and control model at the community level, presenting strategic goals and detailed options for the introduction and application of the approach to communities. It necessary to develop an NCD prevention and control model, consisting of a strategy of community intervention, education for NCD patients, and the enactment of an NCD law that adequately meets the needs of community members.

Application of the chronic care model in hypertension management in community health services / 中华医院管理杂志

Objective To evaluate the effectiveness of Chronic Care Model in hypertension management in community health services.Methods Three hundred patients diagnosed with hypertension participated in this study and were divided into intervention and control groups.In the following 9 months,intervention measures based on the Chronic Care Model were delivered to intervention group,while the conventional measures to control group.Data collected before and after the intervention were analyzed uuing descriptive statistics,t-test,x2-test and analysis of covariance by SPSS16.0 for Windows.Results The intervention group had statistically significant positive effectiveness in drinking habit,daily salt intake(decreased 0.78g),diastolic blood pressure (decreased 2mmHg),BMI(decreased 0.4) and SF-36 physical component summary score(decreased 1.7)(P＜0.05).The intervention group had better improvement in BMI and SF-36 physical component summry score than the control group.Conclusion The health outcomes of patients with hypertension could be improved by applying the Chronic Care Model featured diet,exercise habits and other health related factors management.