Improving diabetes care at primary care level with a multistrategic approach: results of the DIAPREM programme.

AIM: To present results, 1 year postimplementation at primary care level, of an integrated diabetes care programme including systemic changes, education, registry (clinical, metabolic, and therapeutic indicators), and disease management (DIAPREM). METHODS: We randomly selected and trained 15 physicians and 15 nurses from primary care units of La Matanza County (intervention-IG) and another 15 physicians/nurses to participate as controls (control-CG). Each physician-nurse team controlled and followed up 10 patients with type 2 diabetes for 1 year; both groups used structured medical records. Patients in IG had quarterly clinical appointments, whereas those in CG received traditional care. Statistical data analysis included parametric/nonparametric tests according to data distribution profile and Chi-squared test for proportions. RESULTS: After 12 months, the dropout rate was significantly lower in IG than in CG. Whereas in IG HbA1c, blood pressure and lipid profile levels significantly decreased, no changes were recorded in CG. Drug prescriptions showed no significant changes in IG except a decrease in oral monotherapy. CONCLUSIONS: DIAPREM is an expedient and simple multistrategic model to implement at the primary care level in order to decrease patient dropout and improve control and treatment adherence, and quality of care of people with diabetes.

Evaluación de sistemas de salud y la estrategia de APS / Evaluation of health care systems and primary health care strategy

OBJETIVO: evaluar la calidad de los sistemas de salud y la estrategia de Atención Primaria de la Salud (APS) en distintas áreas geográficas del país. MÉTODO: estudio de corte transversal con abordaje metodológico triangular que involucró:a) encuestas a las personas que demandan la atención, b) entrevistas a referentes claves del equipo de salud y c) grupos focales con los equipos de salud. Los componentes de estructura, proceso y resultados de los sistemas de salud basados en APS se evaluaron por medio de indicadores específicos. RESULTADOS:el análisis de la información muestra un déficit evidente de la integración del equipo profesional, principalmente en la actividad comunitaria y social, la carencia de normativas adecuadas y problemas de accesibilidad estructural para población discapacitada. Se destaca, además, el alto porcentaje de personal que desconoce los programas en ejecución dentro de la institución, así como la falta de un sistema de información adecuado sobre la población del área y de registros de los procesos de gestión en la mayoría de las unidades analizadas. CONCLUSIÓN: a pesar de los esfuerzos para definir y ejecutar la estrategia de APS, los centros de salud continúan realizando sus actividades en base al modelo tradicional de atención exclusiva de la demanda

OBJECTIVE: the aim of this project was to evaluate the quality of health care systems based on the strategy of Primary Health Care in different areas of the country. METHOD: cross-sectional study with a triangular approach, including a) a survey to the population demanding care, b) interviews to key referents of the health team, and c)health team focus groups. The components of structure, process and outcomes of the health system based on PHC were evaluated by specific indicators. RESULTS: the analysis of the information shows an evident deficit of the integration of the professional team, mainly in the activities towards community, the lack of norms and lack of facilities for disable people. It must be noted also the high percentage of the health care team that does not know about current institutional health programs and the lack of an adequate information system for the area population and for the administrative process in most of the sites studied. CONCLUSION: in spite of the efforts to implement the PHC strategy, most of health centers evaluated are still providing care based on the traditional model oriented to the demands of care