Service Delivery Redesign for Noncommunicable Disease Management: Assessment of Needs and Solutions Through a Co-Creation Process in Argentina

Autores
Mazzoni, Agustina; Roberti, Javier Eugenio; Guglielmino, Marina; Nadal, Ana María; Mazzaresi, Yanina; Falaschi, Andrea; García, Patricia J.; Espinoza Pajuelo, Laura; Medina Ranilla, Jesús; Leslie, Hannah H.; Portillo, Juan Manuel Gómez; Masier, María Gabriela; Garcia Elorrio, Ezequiel
Año de publicación
2024
Idioma
inglés
Tipo de recurso
artículo
Estado
versión publicada
Descripción
Introduction: In Argentina, the implementation of a national strategy to reduce the prevalence of noncommunicable diseases (NCDs) has been hampered by challenges at the provincial level. We aimed to design a new model of care for NCDs at the primary care level by conducting a multimodal system assessment and co-design of potential solutions in the province of Mendoza.Methods: We carried out a mixed-methods study with 7 components: evaluation of patterns of care, patient focus groups, cross-sectional standardized population-based phone survey, an electronic cohort follow-up of patients with type 2 diabetes, in-depth interviews with stakeholders, a knowledge test for health care providers on chronic condition management, and a Delphi consensus to provide recommendations from stakeholders.Results: Focus group and in-depth interviews revealed access to primary health care for NCDs was associated with problems with long waiting times and time-consuming procedures for referral to laboratory tests, hospital care, and provision of medication. Mental health care services were particularly limited. Survey respondents (N=1,190) were predominantly covered through public (41%) or social security sectors (54%); 41% fell in the lowest income group. Contact with the health system was high (5.7 annual visits), but 19.7% reported unmet health care needs. Public sector providers perceived they provided high-quality care despite insufficient material and human resources. Within the social security sector, the main challenge was insufficient staff, particularly affecting mental health care. Health care providers showed a higher percentage of correct answers to depression-related questions, but worse results were seen in hypertension and diabetes care. Actions supported by evidence and expert agreement were identified for implementation to guide future system changes.Conclusion: Our research highlights the potential for Argentina's primary care system to initiate transformative, system-level changes aimed at improving health outcomes. We propose an innovative methodological assessment and co-design for improving primary care.
Fil: Mazzoni, Agustina. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Roberti, Javier Eugenio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Guglielmino, Marina. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Nadal, Ana María. Ministry Of Health; Argentina. Gobierno de la Provincia de Mendoza. Ministerio de Salud Desarrollo Social y Deportes; Argentina
Fil: Mazzaresi, Yanina. Gobierno de la Provincia de Mendoza. Ministerio de Salud Desarrollo Social y Deportes; Argentina
Fil: Falaschi, Andrea. Gobierno de la Provincia de Mendoza. Ministerio de Salud Desarrollo Social y Deportes; Argentina
Fil: García, Patricia J.. Universidad Peruana Cayetano Heredia;
Fil: Espinoza Pajuelo, Laura. Universidad Peruana Cayetano Heredia;
Fil: Medina Ranilla, Jesús. Universidad Peruana Cayetano Heredia;
Fil: Leslie, Hannah H.. University of California; Estados Unidos
Fil: Portillo, Juan Manuel Gómez. Obra Social de Empleados Públicos de Mendoza; Argentina
Fil: Masier, María Gabriela. Obra Social de Empleados Públicos de Mendoza; Argentina
Fil: Garcia Elorrio, Ezequiel. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina
Materia
SERVICE REDESIGN
PRIMARY CARE
MENDOZA
COCREATION
Nivel de accesibilidad
acceso abierto
Condiciones de uso
https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
Repositorio
CONICET Digital (CONICET)
Institución
Consejo Nacional de Investigaciones Científicas y Técnicas
OAI Identificador
oai:ri.conicet.gov.ar:11336/265317
Acceder
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network_acronym_str CONICETDig
repository_id_str 3498
network_name_str CONICET Digital (CONICET)
spelling Service Delivery Redesign for Noncommunicable Disease Management: Assessment of Needs and Solutions Through a Co-Creation Process in ArgentinaMazzoni, AgustinaRoberti, Javier EugenioGuglielmino, MarinaNadal, Ana MaríaMazzaresi, YaninaFalaschi, AndreaGarcía, Patricia J.Espinoza Pajuelo, LauraMedina Ranilla, JesúsLeslie, Hannah H.Portillo, Juan Manuel GómezMasier, María GabrielaGarcia Elorrio, EzequielSERVICE REDESIGNPRIMARY CAREMENDOZACOCREATIONhttps://purl.org/becyt/ford/3.3https://purl.org/becyt/ford/3Introduction: In Argentina, the implementation of a national strategy to reduce the prevalence of noncommunicable diseases (NCDs) has been hampered by challenges at the provincial level. We aimed to design a new model of care for NCDs at the primary care level by conducting a multimodal system assessment and co-design of potential solutions in the province of Mendoza.Methods: We carried out a mixed-methods study with 7 components: evaluation of patterns of care, patient focus groups, cross-sectional standardized population-based phone survey, an electronic cohort follow-up of patients with type 2 diabetes, in-depth interviews with stakeholders, a knowledge test for health care providers on chronic condition management, and a Delphi consensus to provide recommendations from stakeholders.Results: Focus group and in-depth interviews revealed access to primary health care for NCDs was associated with problems with long waiting times and time-consuming procedures for referral to laboratory tests, hospital care, and provision of medication. Mental health care services were particularly limited. Survey respondents (N=1,190) were predominantly covered through public (41%) or social security sectors (54%); 41% fell in the lowest income group. Contact with the health system was high (5.7 annual visits), but 19.7% reported unmet health care needs. Public sector providers perceived they provided high-quality care despite insufficient material and human resources. Within the social security sector, the main challenge was insufficient staff, particularly affecting mental health care. Health care providers showed a higher percentage of correct answers to depression-related questions, but worse results were seen in hypertension and diabetes care. Actions supported by evidence and expert agreement were identified for implementation to guide future system changes.Conclusion: Our research highlights the potential for Argentina's primary care system to initiate transformative, system-level changes aimed at improving health outcomes. We propose an innovative methodological assessment and co-design for improving primary care.Fil: Mazzoni, Agustina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Roberti, Javier Eugenio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Guglielmino, Marina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Nadal, Ana María. Ministry Of Health; Argentina. Gobierno de la Provincia de Mendoza. Ministerio de Salud Desarrollo Social y Deportes; ArgentinaFil: Mazzaresi, Yanina. Gobierno de la Provincia de Mendoza. Ministerio de Salud Desarrollo Social y Deportes; ArgentinaFil: Falaschi, Andrea. Gobierno de la Provincia de Mendoza. Ministerio de Salud Desarrollo Social y Deportes; ArgentinaFil: García, Patricia J.. Universidad Peruana Cayetano Heredia;Fil: Espinoza Pajuelo, Laura. Universidad Peruana Cayetano Heredia;Fil: Medina Ranilla, Jesús. Universidad Peruana Cayetano Heredia;Fil: Leslie, Hannah H.. University of California; Estados UnidosFil: Portillo, Juan Manuel Gómez. Obra Social de Empleados Públicos de Mendoza; ArgentinaFil: Masier, María Gabriela. Obra Social de Empleados Públicos de Mendoza; ArgentinaFil: Garcia Elorrio, Ezequiel. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaHighWire2024-12info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/resource_type/c_6501info:ar-repo/semantics/articuloapplication/pdfapplication/pdfhttp://hdl.handle.net/11336/265317Mazzoni, Agustina; Roberti, Javier Eugenio; Guglielmino, Marina; Nadal, Ana María; Mazzaresi, Yanina; et al.; Service Delivery Redesign for Noncommunicable Disease Management: Assessment of Needs and Solutions Through a Co-Creation Process in Argentina; HighWire; Global Health: Science and Practice; 12; 6; 12-2024; 1-112169-575XCONICET DigitalCONICETenginfo:eu-repo/semantics/altIdentifier/url/http://www.ghspjournal.org/lookup/doi/10.9745/GHSP-D-24-00208info:eu-repo/semantics/altIdentifier/doi/10.9745/GHSP-D-24-00208info:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by-nc-sa/2.5/ar/reponame:CONICET Digital (CONICET)instname:Consejo Nacional de Investigaciones Científicas y Técnicas2025-09-29T09:55:10Zoai:ri.conicet.gov.ar:11336/265317instacron:CONICETInstitucionalhttp://ri.conicet.gov.ar/Organismo científico-tecnológicoNo correspondehttp://ri.conicet.gov.ar/oai/requestdasensio@conicet.gov.ar; lcarlino@conicet.gov.arArgentinaNo correspondeNo correspondeNo correspondeopendoar:34982025-09-29 09:55:10.548CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicasfalse
dc.title.none.fl_str_mv Service Delivery Redesign for Noncommunicable Disease Management: Assessment of Needs and Solutions Through a Co-Creation Process in Argentina
title Service Delivery Redesign for Noncommunicable Disease Management: Assessment of Needs and Solutions Through a Co-Creation Process in Argentina
spellingShingle Service Delivery Redesign for Noncommunicable Disease Management: Assessment of Needs and Solutions Through a Co-Creation Process in Argentina
Mazzoni, Agustina
SERVICE REDESIGN
PRIMARY CARE
MENDOZA
COCREATION
title_short Service Delivery Redesign for Noncommunicable Disease Management: Assessment of Needs and Solutions Through a Co-Creation Process in Argentina
title_full Service Delivery Redesign for Noncommunicable Disease Management: Assessment of Needs and Solutions Through a Co-Creation Process in Argentina
title_fullStr Service Delivery Redesign for Noncommunicable Disease Management: Assessment of Needs and Solutions Through a Co-Creation Process in Argentina
title_full_unstemmed Service Delivery Redesign for Noncommunicable Disease Management: Assessment of Needs and Solutions Through a Co-Creation Process in Argentina
title_sort Service Delivery Redesign for Noncommunicable Disease Management: Assessment of Needs and Solutions Through a Co-Creation Process in Argentina
dc.creator.none.fl_str_mv Mazzoni, Agustina
Roberti, Javier Eugenio
Guglielmino, Marina
Nadal, Ana María
Mazzaresi, Yanina
Falaschi, Andrea
García, Patricia J.
Espinoza Pajuelo, Laura
Medina Ranilla, Jesús
Leslie, Hannah H.
Portillo, Juan Manuel Gómez
Masier, María Gabriela
Garcia Elorrio, Ezequiel
author Mazzoni, Agustina
author_facet Mazzoni, Agustina
Roberti, Javier Eugenio
Guglielmino, Marina
Nadal, Ana María
Mazzaresi, Yanina
Falaschi, Andrea
García, Patricia J.
Espinoza Pajuelo, Laura
Medina Ranilla, Jesús
Leslie, Hannah H.
Portillo, Juan Manuel Gómez
Masier, María Gabriela
Garcia Elorrio, Ezequiel
author_role author
author2 Roberti, Javier Eugenio
Guglielmino, Marina
Nadal, Ana María
Mazzaresi, Yanina
Falaschi, Andrea
García, Patricia J.
Espinoza Pajuelo, Laura
Medina Ranilla, Jesús
Leslie, Hannah H.
Portillo, Juan Manuel Gómez
Masier, María Gabriela
Garcia Elorrio, Ezequiel
author2_role author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv SERVICE REDESIGN
PRIMARY CARE
MENDOZA
COCREATION
topic SERVICE REDESIGN
PRIMARY CARE
MENDOZA
COCREATION
purl_subject.fl_str_mv https://purl.org/becyt/ford/3.3
https://purl.org/becyt/ford/3
dc.description.none.fl_txt_mv Introduction: In Argentina, the implementation of a national strategy to reduce the prevalence of noncommunicable diseases (NCDs) has been hampered by challenges at the provincial level. We aimed to design a new model of care for NCDs at the primary care level by conducting a multimodal system assessment and co-design of potential solutions in the province of Mendoza.Methods: We carried out a mixed-methods study with 7 components: evaluation of patterns of care, patient focus groups, cross-sectional standardized population-based phone survey, an electronic cohort follow-up of patients with type 2 diabetes, in-depth interviews with stakeholders, a knowledge test for health care providers on chronic condition management, and a Delphi consensus to provide recommendations from stakeholders.Results: Focus group and in-depth interviews revealed access to primary health care for NCDs was associated with problems with long waiting times and time-consuming procedures for referral to laboratory tests, hospital care, and provision of medication. Mental health care services were particularly limited. Survey respondents (N=1,190) were predominantly covered through public (41%) or social security sectors (54%); 41% fell in the lowest income group. Contact with the health system was high (5.7 annual visits), but 19.7% reported unmet health care needs. Public sector providers perceived they provided high-quality care despite insufficient material and human resources. Within the social security sector, the main challenge was insufficient staff, particularly affecting mental health care. Health care providers showed a higher percentage of correct answers to depression-related questions, but worse results were seen in hypertension and diabetes care. Actions supported by evidence and expert agreement were identified for implementation to guide future system changes.Conclusion: Our research highlights the potential for Argentina's primary care system to initiate transformative, system-level changes aimed at improving health outcomes. We propose an innovative methodological assessment and co-design for improving primary care.
Fil: Mazzoni, Agustina. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Roberti, Javier Eugenio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Guglielmino, Marina. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Nadal, Ana María. Ministry Of Health; Argentina. Gobierno de la Provincia de Mendoza. Ministerio de Salud Desarrollo Social y Deportes; Argentina
Fil: Mazzaresi, Yanina. Gobierno de la Provincia de Mendoza. Ministerio de Salud Desarrollo Social y Deportes; Argentina
Fil: Falaschi, Andrea. Gobierno de la Provincia de Mendoza. Ministerio de Salud Desarrollo Social y Deportes; Argentina
Fil: García, Patricia J.. Universidad Peruana Cayetano Heredia;
Fil: Espinoza Pajuelo, Laura. Universidad Peruana Cayetano Heredia;
Fil: Medina Ranilla, Jesús. Universidad Peruana Cayetano Heredia;
Fil: Leslie, Hannah H.. University of California; Estados Unidos
Fil: Portillo, Juan Manuel Gómez. Obra Social de Empleados Públicos de Mendoza; Argentina
Fil: Masier, María Gabriela. Obra Social de Empleados Públicos de Mendoza; Argentina
Fil: Garcia Elorrio, Ezequiel. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina
description Introduction: In Argentina, the implementation of a national strategy to reduce the prevalence of noncommunicable diseases (NCDs) has been hampered by challenges at the provincial level. We aimed to design a new model of care for NCDs at the primary care level by conducting a multimodal system assessment and co-design of potential solutions in the province of Mendoza.Methods: We carried out a mixed-methods study with 7 components: evaluation of patterns of care, patient focus groups, cross-sectional standardized population-based phone survey, an electronic cohort follow-up of patients with type 2 diabetes, in-depth interviews with stakeholders, a knowledge test for health care providers on chronic condition management, and a Delphi consensus to provide recommendations from stakeholders.Results: Focus group and in-depth interviews revealed access to primary health care for NCDs was associated with problems with long waiting times and time-consuming procedures for referral to laboratory tests, hospital care, and provision of medication. Mental health care services were particularly limited. Survey respondents (N=1,190) were predominantly covered through public (41%) or social security sectors (54%); 41% fell in the lowest income group. Contact with the health system was high (5.7 annual visits), but 19.7% reported unmet health care needs. Public sector providers perceived they provided high-quality care despite insufficient material and human resources. Within the social security sector, the main challenge was insufficient staff, particularly affecting mental health care. Health care providers showed a higher percentage of correct answers to depression-related questions, but worse results were seen in hypertension and diabetes care. Actions supported by evidence and expert agreement were identified for implementation to guide future system changes.Conclusion: Our research highlights the potential for Argentina's primary care system to initiate transformative, system-level changes aimed at improving health outcomes. We propose an innovative methodological assessment and co-design for improving primary care.
publishDate 2024
dc.date.none.fl_str_mv 2024-12
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
http://purl.org/coar/resource_type/c_6501
info:ar-repo/semantics/articulo
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/11336/265317
Mazzoni, Agustina; Roberti, Javier Eugenio; Guglielmino, Marina; Nadal, Ana María; Mazzaresi, Yanina; et al.; Service Delivery Redesign for Noncommunicable Disease Management: Assessment of Needs and Solutions Through a Co-Creation Process in Argentina; HighWire; Global Health: Science and Practice; 12; 6; 12-2024; 1-11
2169-575X
CONICET Digital
CONICET
url http://hdl.handle.net/11336/265317
identifier_str_mv Mazzoni, Agustina; Roberti, Javier Eugenio; Guglielmino, Marina; Nadal, Ana María; Mazzaresi, Yanina; et al.; Service Delivery Redesign for Noncommunicable Disease Management: Assessment of Needs and Solutions Through a Co-Creation Process in Argentina; HighWire; Global Health: Science and Practice; 12; 6; 12-2024; 1-11
2169-575X
CONICET Digital
CONICET
dc.language.none.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv info:eu-repo/semantics/altIdentifier/url/http://www.ghspjournal.org/lookup/doi/10.9745/GHSP-D-24-00208
info:eu-repo/semantics/altIdentifier/doi/10.9745/GHSP-D-24-00208
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
eu_rights_str_mv openAccess
rights_invalid_str_mv https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv HighWire
publisher.none.fl_str_mv HighWire
dc.source.none.fl_str_mv reponame:CONICET Digital (CONICET)
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reponame_str CONICET Digital (CONICET)
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instname_str Consejo Nacional de Investigaciones Científicas y Técnicas
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repository.mail.fl_str_mv dasensio@conicet.gov.ar; lcarlino@conicet.gov.ar
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score 13.070432

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