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The rationale for integrated care deployment to chronic patients in Ecuador and proposals to act locally: results from a mixed method study

Authors:

Iván Dueñas-Espín ,

Institute of Public Health, Postgraduate Program of Family and Community Medicine, Faculty of Medicine, Pontifical Catholic University of Ecuador, PUCE, Quito, EC
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Sandra Aguayo-Macias,

Ecuadorian Ministry of Public Health, MSP, Portoviejo, EC
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Roberto Coellar Zambrano,

Ecuadorian Ministry of Public Health, MSP, Portoviejo, EC
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Richard Macías,

Ecuadorian Ministry of Public Health, MSP, Portoviejo, EC
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Karina Moreira Mendoza,

Ecuadorian Ministry of Public Health, MSP, Portoviejo, EC
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Luis Gonzalo Salazar Velez,

Ecuadorian Ministry of Public Health, MSP, Portoviejo, EC
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Virginia Vélez

Ecuadorian Ministry of Public Health, MSP, Portoviejo, EC
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Abstract

Introduction: Integrated care (IC) has potential to improve health care experience and treatment adherence by properly coordinated and stratified care. We aimed to: (i) assess the patients’ perception about the degree of integrality in their care, (ii) identify potential predictors for risk assessment; and, (iii) assess clinicians’ and patients’ expectations about the involvement of general practitioners (GP) specialists in chronic care.

Methods: mixed methods study. Cross sectional study: Two subsets of chronic patients (total n=416) attended by three public health care centres in Portoviejo – Ecuador were studied. In first subset (n=111) we searched for independent associations between sociodemographic and clinical variables with perception of integrality in their care by Patient Assessment of Care for Chronic Conditions (PACIC) instrument. In second subset (n=305), we searched for independent associations between clinical data –collected by “the passport to a healthy lifestyle”–, BMI, diagnoses, and self-rated health with: (i) representations of illness by the Brief Illness Perception Questionnaire (BIPQ) questionnaire, and (ii) any hospitalization in last year. Qualitative research: Two focus groups, focused on finding out expectations of future involvement of GP specialists in chronic care, subsequent transcription and discursive analyses were performed.

Results: Patients were, mostly, female, median age of 59 years old, low educated, married, unemployed, and without social security. First subset: median (P25 to P75) PACIC score was 4 (3.2 to 4.8) points, ageing, male sex and longer duration of the disease were associated with a lower PACIC score. Second subset: ageing, low education, and unemployment were associated with lower BIPQ score. Abnormal BMI, fair to poor self-rated health, and multimorbidity were associated to any hospitalization in last year (aOR=2.8, 95%CI: 1.0 to 8.0; aOR=2.3, 95%CI: 1.0 to 5.9; and, aOR=2.5, 95%CI: 1.1 to 5.8, respectively). Physicians and patients considered that there is scarce or poor integrality in chronic care and that IC is necessary; further, involvement of GP specialists is seen as it would improve chronic care.

Discussion: Cross sectional approach does not let to properly establish predictors of adverse outcomes, but our results suggest there is potential for practical risk assessment. Massive recruitment of GP specialists is a well-perceived strategy by patients and physicians, but subsequent IC deployment in Ecuador requires further structural changes.

Conclusions and lessons learned: Fragmented care is provided to patients in Portoviejo. We provide a rationale for recruiting GP specialists and subsequent IC adoption. Ageing and social factors contribute to a poorer understanding of the disease, which deserves special attention by healthcare workers. BMI, number of diseases, and self-rated health are potential predictors for risk assessment – an IC core component–; in that regard, “the passport” could be a contribution to the adoption of IC.

Limitations: The convenience sampling could exclude high risk patients; nevertheless, it is estimated that public health centres cover 60% of the population; further, given that low educated patients were included, we believe that high risk stratum was properly represented.

Suggestions for future research: Longitudinal follow-up of a large sample of Ecuadorian patients is desirable to corroborate proposed risk predictors.

How to Cite: Dueñas-Espín I, Aguayo-Macias S, Coellar Zambrano R, Macías R, Moreira Mendoza K, Gonzalo Salazar Velez L, et al.. The rationale for integrated care deployment to chronic patients in Ecuador and proposals to act locally: results from a mixed method study. International Journal of Integrated Care. 2019;19(4):53. DOI: http://doi.org/10.5334/ijic.s3053
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Published on 08 Aug 2019.

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