Chronic viral hepatitis C micro-elimination program using telemedicine. The Mexican experience.

BACKGROUND: hepatitis C virus (HCV) infection is a global health problem. Chronic infection induces the development of fibrosis and cirrhosis together with all the related complications. The use of direct-acting antiviral (DAA) drugs has proven highly effective. Telemedicine is a present-day resource that brings treatment closer to distant areas and may result in cost savings. OBJECTIVE: to implement a microelimination program for HCV using DAAs with the support of a telemedicine program to minimize expenses. PATIENTS AND METHODS: the program was developed at the Medical Services department of Petróleos Mexicanos (SMPM) with a national coverage; patients diagnosed with chronic hepatitis C were included. These were classified into locals and outsiders. Treatment for foreign patients was indicated, monitored and completed via telemedicine. Thus, avoiding their travel to the country's capital city, in order to save on transportation costs and travel allowances. RESULTS: a total of 136 patients, 74 locals and 62 outsiders, participated in the study. Transfer was avoided for 62 patients (45.5 %), which meant that telemedicine resulted in savings of 3,176.20 USD per patient, with overall savings of 196,924.40 USD from cost minimization. A total of 30 patients remained untreated due to lack of medication, hence the coverage amounted to 86 %. Sustained virological response (SVR) was achieved in 99 % of cases. Only two patients had treatment failure. Adverse events included headache and fatigue in 5 % of the cohort. CONCLUSIONS: with the aid of a telemedicine approach, significant savings were achieved by minimizing costs, since nearly half of patients were outsiders. Coverage reached 86 % and treatment with DAAs was successful for 99 % of our cases.

Design and validation of an instrument to evaluate Person-Centered care in health services.

BACKGROUND: The concept of quality in health care has evolved, placing greater importance on the patient's needs, culture, and social context, as well as their participation in clinical decision-making, as highlighted by Mead and Bower's Person-Centered Care Model. The aim of the present study was to design and validate an instrument to assess the extent to which healthcare services provided by PEMEX (Petróleos Mexicanos) offer person-centered care according to user perceptions. METHODS: The first phase comprised the development of 57 items based on the analysis of responses from an open-ended questionnaire administered to 30 users of Pemex healthcare services. This questionnaire was designed considering the four factors of the person-centered care model, however, the high correlation between the 4 factors (i.e., r ≥ .80) indicated an overfactoring effect and consequently an increase in the risk of overfitting. Therefore, an exhaustive analysis of the instrument was performed, starting with the review of the individual behavior of each item, and carrying out exploratory and confirmatory factor analysis. Using a sample of 330 individuals, an exploratory factor analysis was perfomed. Afterward, a confirmatory factorial analysis was carried out with 335 participants. Finally, a new confirmatory factorial analysis included 130 participants due to the refinements made in the previous phase. Internal consistency was assessed using Cronbach's α and McDonald's ω at every phase. RESULTS: The exploratory factor analysis retained 35 items in a single factor that accounted for 49% of the variance with an internal consistency of Cronbach's α and McDonald's ω = 0.97. Because the factorial structure by confirmatory factorial analysis was unsatisfactory, the initial model was refined, leading to the retention of 11 items and a final model with adjustment index of χ2 = 127.53, χ2/gl = 2.89, RMSEA = 0.07, IC RMSEA 0.06 to 0.09, TLI = 0.95 and CFI = 0.96, with an internal consistency of Cronbach's α and McDonald's ω = 0.93. Due to the refinements, a new confirmatory factorial analysis was conducted with suitable goodness-of-fit criteria in most items (χ2 = 151.44, χ2/gl = 3.43, RMSEA = 0.13, IC RMSEA 0.11 to 0.16, TLI = 0.93 and CFI = 0.94), resulting in a Cronbach's α and McDonald's ω = 0.98. CONCLUSIONS: The instrument exhibits suitable psychometric properties to be employed to measure the degree to which medical care is patient centered. This instrument represents a strategy for promoting an innovative healthcare model.