Details

Autor(en) / Beteiligte

• González Block, Miguel Ángel
• Díaz Portillo, Sandra Patricia
• Morales, Hortensia Reyes
• Rodríguez Saldaña, Joel
• Gutiérrez Calderón, Emilio

Titel

Diabetes care innovation in the Mexican Institute for Social Insurance: Scaling up the preventive chronic disease care model to address critical coverage constraints

Ist Teil von

• Primary care diabetes, 2021-04, Vol.15 (2), p.314-322

Ort / Verlag

England: Elsevier Ltd

Erscheinungsjahr

2021

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• •Up to 13.1% of IMSS adult beneficiaries live with diabetes, with women being more affected.•Overall quality of care is low, with an average of 37.0% among beneficiaries treated by IMSS, while 38.1% achieve A1c <7%.•Care innovation scale-up faces internal context and process challenges.•Greater autonomy and performance incentives could address critical constraints. With diabetes prevalence in Mexico at 11.3% of adults, the Mexican Institute of Social Insurance (IMSS) is piloting the Chronic Disease Preventive Model (CDPM). CDPM includes intensive patient education, care by multidisciplinary teams and risk management in primary care. The objective of this article is to determine CDPM coverage bottlenecks and to explore facilitators and barriers to implementation. The National Health and Nutrition Survey 2018 was processed to identify key diabetes prevalence, coverage, quality and outcome indicators. Key IMSS informant interviews and document content analyses were undertaken following the Tanahashi coverage decay model and the Consolidated Framework for Implementation Research (CFIR). IMSS screens 49% of adult beneficiaries for diabetes but only 26% with presumptive diagnosis proceed to confirmation. Out of 4.1 million adults with diabetes, IMSS diagnoses 94% and treats 85%. Medications are received by 90% of patients but only 63% of those requiring insulin receive it. The overall quality of care indicator attains 37% of potential. Coverage of diabetes education, monitoring with HbA1c and interdisciplinary care are 20%, 15% and 3%, respectively. Among IMSS beneficiaries treated by the institute 38.1% have HbA1c levels below 7% and 26.1% have levels above 9%. CDPM facilitators are the perceived threat of uncontrolled diabetes, compatibility of innovation values and willingness for institutional learning. Barriers are centralized decision making, functional differentiation across managers and practitioners and lack of incentives, resource shortages and the lack of measures to ensure fidelity. CDPM scale-up has to address organizational and process barriers while ensuring the necessary resources for sustainability.