Evaluation of the implementation progress through key performance indicators in a new multimorbidity patient-centered care model in Chile.

BACKGROUND: Complex health interventions involve deep organizational, structural, and cultural changes that challenge health teams and decision-makers. The explosion of chronic diseases has made the multimorbidity approach a global priority. The Centro de Innovación en Salud ANCORA UC implemented a Multimorbidity Patient-Centered Care Model in the Chilean public health system. OBJECTIVE: This study aims to evaluate the progress of the implementation of the Multimorbidity Patient-Centered Care Model in seven primary care centers through key performance indicators. METHODS: a set of indicators was designed to evaluate change management, operations, installation of new roles, and services and activities of the intervention strategy of the model. Key performance indicators were identified to monitor the implementation progress on minimal components for the model's sustainability. Each item was assigned against an expected minimum score of 67% of progress from the overall score. They were monitored twice in seven primary health centers in 2019 and 2020, which intervened 22,642 patients with the intervention. RESULTS: The results showed that six of the seven primary care centers reached the minimum implementation threshold. The main advances were in operational conditions, and those with minor progress in implementation were the clinical services. Population size, organization, coordination of the health care teams, additional training, and decision-makers support were key factors that determined the degree of progress in a complex intervention. CONCLUSION: It was possible to measure the progression of the implementation of a complex intervention through key performance indicators delivering relevant information for decision-makers that pursue a successful and faithful implementation. This study provides a valuable tool for the national scale-up of a similar model started in Chile by the Ministry of Health and other countries.

[Teaching medical students about domestic violence and sexual abuse: teachers' perception of barriers and facilitators]. / Docencia en violencia y abuso sexual en estudiantes de pregrado de medicina: percepción de los docentes sobre barreras y facilitadores.

BACKGROUND: Considering the frequency of sexual abuse and domestic violence (SA-DV) in the population, the likelihood of a medical student meeting patients with this problem is substantial. However, most students do not consider SA-DV in their differential diagnoses. Since 2014, this team has been working in strengthening undergraduate curriculum in SA-DV. It has been a challenging and slow process. PURPOSE: To identify barriers and facilitators perceived by the undergraduate teaching team in order to suggest modifications in the curriculum in relation to the competencies required for screening and early intervention for victims of SA-DV. The conclusions obtained may be useful for other medical schools and universities facing this challenge. METHODS: Qualitative study using grounded theory method for the analysis of interviews and focus groups. RESULTS: SA-DV are perceived as a problem that is pertinent for physicians. However, there is a common belief that teaching about SA-DV should be limited to only certain specific specialties. The main barriers are the limited curricular time, the need to prioritize contents and the lack of specific training of the teachers. A key facilitator is the fact that gender violence is on the public agenda today. CONCLUSIONS: The identified barriers coincide with those reported in the literature; limited curricular time and prioritization of contents. Although this study does not show the perception of SA-DV as 'not a medical issue' nor as a subject that pertains to other health professionals, there is the perception that teaching clinical approach to SA-DV only pertains to specialists who are directly involved in this topic.

Docencia en violencia y abuso sexual en estudiantes de pregrado de medicina: percepción de los docentes sobre barreras y facilitadores / Teaching medical students about domestic violence and sexual abuse: teachers' perception of barriers and facilitators

Background: Considering the frequency of sexual abuse and domestic violence (SA-DV) in the population, the likelihood of a medical student meeting patients with this problem is substantial. However, most students do not consider SA-DV in their differential diagnoses. Since 2014, this team has been working in strengthening undergraduate curriculum in SA-DV. It has been a challenging and slow process. Purpose: To identify barriers and facilitators perceived by the undergraduate teaching team in order to suggest modifications in the curriculum in relation to the competencies required for screening and early intervention for victims of SA-DV. The conclusions obtained may be useful for other medical schools and universities facing this challenge. Methods: Qualitative study using grounded theory method for the analysis of interviews and focus groups. Results: SA-DV are perceived as a problem that is pertinent for physicians. However, there is a common belief that teaching about SA-DV should be limited to only certain specific specialties. The main barriers are the limited curricular time, the need to prioritize contents and the lack of specific training of the teachers. A key facilitator is the fact that gender violence is on the public agenda today. Conclusions: The identified barriers coincide with those reported in the literature; limited curricular time and prioritization of contents. Although this study does not show the perception of SA-DV as 'not a medical issue' nor as a subject that pertains to other health professionals, there is the perception that teaching clinical approach to SA-DV only pertains to specialists who are directly involved in this topic.

'If I feel something wrong, then I will get a mammogram': understanding barriers and facilitators for mammography screening among Chilean women.

BACKGROUND: Breast cancer is the leading cause of cancer among women in Chile and in many Latin American countries. Breast cancer screening is an effective strategy to reduce mortality, but it has a very low compliance among Chilean women. OBJECTIVE: To understand barriers and facilitators for breast cancer screening in a group of Chilean women aged 50-70. METHODS: Following the Predisposing, Enabling and Reinforcing (PRECEDE) framework, seven focus groups (N = 48 women) were conducted with women that have had diverse experiences with breast cancer and screening practices. Information was collected using field notes and audio and video recording. Following the grounded theory model, a sequential process of open, axial and selective coding was used for the information analysis. Atlas ti 5.5 software was used for coding and segmenting the data obtained from the interviews. RESULTS: The presence of symptoms and/or the finding of lumps through breast self-examination (BSE) were the main predisposing factors for getting a mammogram. Secrecy, embarrassment and fatalism about breast cancer were significant cultural factors that influenced the decision to seek mammogram screening. Confidence in medical staff and dignity in the treatment at the clinic were important enabling factors. The main reinforcing factors for getting the test were a sense of fulfilment by doing something good for themselves and getting timely information about the results. CONCLUSIONS: Primary health care providers should use culturally appropriate strategies to better inform women about the importance of mammography screening and the limitations of BSE for preventing advanced breast cancer.