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

Primary Care Diabetes
Miguel Ángel González BlockEmilio Gutiérrez Calderón

Abstract

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 insti...Continue Reading

References

Apr 18, 2008·Journal of Health Services Research & Policy·Alicia O'CathainJon Nicholl
Aug 16, 2013·Human Resources for Health·Robert Kaba AlhassanTobias F Rinke de Wit
Mar 8, 2016·Patient Education and Counseling·Mireya GamiochipiUNKNOWN DIMSS Study Group
Mar 28, 2017·Primary Care Diabetes·Niels H WacherVíctor H Borja-Aburto
Jul 14, 2017·Clinical Diabetes and Endocrinology·Paul Z Zimmet
Aug 14, 2019·JAMA Internal Medicine·Pooyan KazemianDeborah J Wexler
Dec 22, 2019·Diabetes Care·UNKNOWN American Diabetes Association
Dec 24, 2019·Salud pública de México·Ana Basto-AbreuSalvador Villalpando

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