A complex intervention to support breastfeeding: A feasibility and acceptability study.

AIMS: The aims of this study are to assess the acceptability and feasibility of a multicomponent intervention to support breastfeeding women and their families and explore its effectiveness. METHODS: A pilot study with control and intervention groups was conducted using the complex intervention framework in two primary healthcare centres. Overall, 44 childbearing women, their partners/relatives and 20 healthcare professionals participated in the study. The intervention's feasibility and acceptability were measured. The percentage of exclusive breastfeeding rates and women's self-efficacy were measured at pre-intervention, at 10 days postpartum, and again at 2, 4 and 6 months postpartum. Postpartum depression risk was measured at 2 and 6 months postpartum. Professional self-efficacy was measured at pre-intervention and 3 months later. RESULTS: The intervention was feasible and acceptable. No difference in self-efficacy existed between the intervention and control groups. Preliminary effects of the intervention were found in exclusive breastfeeding percentage and postpartum depression risk in the intervention group. CONCLUSION: The intervention is feasible and acceptable. The results are promising not only for breastfeeding maintenance but also for preventing postpartum depression and recovering exclusive breastfeeding during pandemics. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT03944642.

Advancing towards the implementation of patient-centred care in Chile: An opportunity to effectively practice shared decision-making.

In Chile, local normative and guidelines place patient-centred care (PCC) as a desirable means and outcome for each level of health care. Thus, a definition of PCC is provided, and for the first time shared decision-making (SDM) is included as an intended practice. During the past five years the country has shown progress on the implementation of PCC. A large pilot study was conducted in one of the Metropolitan Health Services, and now the health authority is committed to escalate a PCC strategy nationwide. From the practice domain, most of the work is being placed on the training of health professionals. Patients' preparation for the clinical encounter is scarce, thereby limiting their potential to participate in their care. At the research domain, the country shows a strengthened agenda that has advanced from a diagnostic phase (including the exploration from social sciences) to a purposeful stage which involves the development of training programs, patient decision aids, international collaborations, and other PCC interventions. The country is now positioned to secure new initiatives to empower patients and allow them to take an active role, as a key component of PCC and SDM.

Diabetic ketoacidosis and COVID-19: what have we learned so far?

In December 2019, a pandemic emerged due to a new coronavirus that imposed various uncertainties and discoveries. It has been reported that diabetes is a risk factor for worst outcomes of COVID-19 and also that SARS-CoV-2 infection was correlated with the occurrence of diabetic ketoacidosis (DKA) in patients. The aim of this work is to discuss this correlation emphasizing the main case reports from 2020 while exploring the management of DKA during the course of COVID-19. Web of Science, PubMed, and Scopus databases were searched using two sets of Medical Subject Heading (MeSH) search terms or Title/Abstract words: Coronavirus Infections (Coronavirus Infections, Middle East Respiratory Syndrome, COVID-19) and Diabetic Ketoacidosis (Diabetic Ketoacidosis, Diabetic Acidosis, Diabetic Ketosis). There is a clear correlation between COVID-19 and DKA. The SARS-Cov-2 infection may precipitate both a hyperglycemic state and ketoacidosis occurrence in patients with diabetes and nondiabetic patients, which may lead to fatal outcomes. DKA in patients with COVID-19 may increase risk and worse outcomes. Hence, the SARS-Cov-2 infection presents a new perspective toward the management of glycemia and acidosis in patients with diabetes and nondiabetic patients, highlighting the need for rapid interventions to minimize the complications from COVID-19 while reducing its spreading.

Technology-Assisted Collaborative Care Program for People with Diabetes and/or High Blood Pressure Attending Primary Health Care: A Feasibility Study.

The comorbidity of depression with physical chronic diseases is usually not considered in clinical guidelines. This study evaluated the feasibility of a technology-assisted collaborative care (TCC) program for depression in people with diabetes and/or high blood pressure (DM/HBP) attending a primary health care (PHC) facility in Santiago, Chile. Twenty people diagnosed with DM/HBP having a Patient Health Questionnaire-9 score ≥ 15 points were recruited. The TCC program consisted of a face-to-face, computer-assisted psychosocial intervention (CPI, five biweekly sessions), telephone monitoring (TM), and a mobile phone application for behavioral activation (CONEMO). Assessments of depressive symptoms and other health-related outcomes were made. Thirteen patients completed the CAPI, 12 received TM, and none tried CONEMO. The TCC program was potentially efficacious in treating depression, with two-thirds of participants achieving response to depression treatment 12 weeks after baseline. Decreases were observed in depressive symptoms and healthcare visits and increases in mental health-related quality of life and adherence to treatment. Patients perceived the CPI as acceptable. The TCC program was partially feasible and potentially efficacious for managing depression in people with DM/HBP. These data are valuable inputs for a future randomized clinical trial.

A collaborative, computer-assisted, psycho-educational intervention for depressed patients with chronic disease at primary care: protocol for a cluster randomized controlled trial.

BACKGROUND: Depression and chronic diseases are frequently comorbid public health problems. However, clinical guidelines often fail to consider comorbidities. This study protocol describes a cluster randomized trial (CRT) aimed to compare the effectiveness of a collaborative, computer-assisted, psycho-educational intervention versus enhanced usual care (EUC) in the treatment of depressed patients with hypertension and/or diabetes in primary care clinics (PCC) in Santiago, Chile. METHODS: Two-arm, single-blind, CRT carried out at two municipalities in Santiago, Chile. Eight PCC will be randomly assigned (1:1 ratio within each municipality, 4 PCC in each municipality) to the INTERVENTION or EUC. A total of 360 depressed patients, aged at least 18 years, with Patient Health Questionnaire-9 Item [PHQ-9] scores ≥15, and enrolled in the Cardiovascular Health Program at the participating PCC. Patients with alcohol/substance abuse; current treatment for depression, bipolar disorder, or psychosis; illiteracy; severe impairment; and resident in long-term care facilities, will be excluded. Patients in both arms will be invited to use the Web page of the project, which includes basic health education information. Patients in the INTERVENTION will receive eight sessions of a computer-assisted, psycho-educational intervention delivered by trained therapists, a structured telephone calls to monitor progress, and usual medical care for chronic diseases. Therapists will receive biweekly and monthly supervision by psychologist and psychiatrist, respectively. A monthly meeting will be held between the PCC team and a member of the research team to ensure continuity of care. Patients in EUC will receive depression treatment according to clinical guidelines and usual medical care for chronic diseases. Outcome assessments will be conducted at 3, 6, and 12 months after enrollment. The primary outcome will be depression improvement at 6 months, defined as ≥50% reduction in baseline PHQ-9 scores. Intention-to-treat analyses will be performed. DISCUSSION: This study will be one of the first to provide evidence for the effectiveness of a collaborative, computer-assisted, psycho-educational intervention for depressed patients with chronic disease at primary care in a Latin American country. TRIAL REGISTRATION: retrospectively registered in ClinicalTrials.gov , first posted: November 3, 2020, under identifier: NCT04613076 .

The CRIAA Program complex intervention in primary care to support women and their families in breastfeeding: Study protocol for a pilot trial.

AIM: To report a pilot study protocol to assess the feasibility of a complex intervention, in the primary healthcare context, to support women and their families in breastfeeding. DESIGN: A pilot/feasibility trial with control and intervention groups. METHODS: The study will be conducted in two primary healthcare centres with 40 childbearing women (20 control group; 20 intervention group), with their partner/meaningful person and their respective healthcare professionals. Intervention group participants will receive the intervention: (a) in a breastfeeding workshop during their third trimester of pregnancy; and (b) via virtual breastfeeding support for six months postpartum. Health professionals will be trained to deliver the intervention. The control group will receive standard care in the outpatient clinic. The pilot will help determine the intervention's feasibility. Data collected pre-intervention, 10-days postpartum and two-, four-, and six-months postpartum will provide estimates of the intervention's preliminary effects on self-efficacy and main outcomes. Research Ethics Committee approval was obtained in April 2019. DISCUSSION: Breastfeeding support is a complex reality influenced by multiple factors. Therefore, approaches to breastfeeding are also, requiring interventions that address its multidimensional nature, including all actors involved. The proposed intervention will be applied by an interdisciplinary professional health team, allowing for its incorporation into standard practice and its perpetual maintenance. IMPACT: The study will produce an original, comprehensive, complex intervention addressing contextual, and organizational factors to promote breastfeeding support using an interdisciplinary and family-based approach; breastfeeding self-efficacy is the core concept. The program evaluation and feasibility study will permit exploration of the integration of the intervention's novel aspects into the daily work of professionals and reveal how to better use existing resources in a full-scale clinical trial. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT03944642.

Perceptions on technology for volunteer respite care for bedridden elders in Chile.

PURPOSE:  Informal caregivers of bedridden elders need a respite. One form of obtaining a respite is through volunteers who are contacted by means of information and communication technology (ICT). METHOD:  A qualitative study was carried out in a low-income district in Santiago, Chile, to learn about how caregivers of bedridden elders perceive the possibility of using ICT to access this respite. In-depth interviews were carried out and transcribed verbatim, then analysed using open coding. Results: The results reveal that caregivers are willing to receive a volunteer in their home and use ICT to communicate with them, although a discrepancy exists between the use of devices connected to the Internet and feature phones. Conclusion: This study concludes that informal caregivers of bedridden elders have a favourable disposition towards accessing a respite system by means of ICT based on a peer-to-peer economy.

Patient-centred care and shared decision making in Chile: Rising momentum for progress and implementation in clinical practice.

The Chilean legislation establishes that patients have rights and responsibilities in regards to their healthcare. This is an important statement as it declares that people must be informed and become actively involved in their care; meanwhile, the health system needs to coordinate the provision of personalised and effective services. Although patient-centred care (PCC) and shared decision making (SDM) are relatively new concepts in Chile, the country is experiencing an interesting political momentum to create more interventions to achieve PCC and SDM and explore clinical implementation. Currently, research efforts in Chile have focused on better understanding the state of the art related to both concepts and how new clinical approaches could help to operationalize them.

Evaluación del Modelo multicomponente de telecuidado de apoyo a personas con prediabetes y obesidad en Chile

Antecedentes: la prediabetes es una condición reversible y su tratamiento una oportunidad para modificar prácticas no saludables. Objetivo: evaluar la efectividad del Modelo Multi-componente de Telecuidado para apoyo a personas con prediabetes y obesidad en Chile. Método: ensayo clínico controlado en centros de atención primaria, Santiago, Chile. Se realizó un muestreo y asignación aleatoria en cada uno de los 5 centros de salud participantes. Participantes: 70 adultos con pre-diabetes, IMC: 25-34 y acceso a telefonía móvil. GI (n = 33), recibió modelo: consejerías telefónicas, envío de SMS, material educativo y equipos auto-monitoreo; y GC (n = 32) atención habitual atención habitual y equipos de auto-monitoreo. Medición pre y post intervención de los conocimientos sobre Prediabetes, alimentación no saludable, actividad física, peso, circunferencia de cintura, Glicemia, Triglicéridos y Colesterol Total. Resultados: en el GI, la intervención fue efectiva en mantener estable el nivel de conocimientos sobre pre-diabetes y disminuir nivel de triglicéridos. El modelo no superó a la atención habitual en disminución del peso, circunferencia de cintura, glicemia y colesterol total.

Background: Prediabetes is a reversible condition and its treatment a chance to change unhealthy practices. Objective: to evaluate the effectiveness of a multi-component tele-care model to support people with pre-diabetes and obesity in Chile. Method: a randomized clinical trial in primary care setting, Santiago, Chile. Participants: 70 adults with pre-diabetes: BMI between 25 and 34 and access to mobile phone. GI (n = 33) received telephone counseling, SMS, educational materials and self-monitoring equipment and GC (n = 32) usual care and self-monitoring equipment. Measures of knowledge of prediabetes, unhealthy diet, physical activity, weight, waist circumference, glucose, triglycerides and total cholesterol were made pre and post intervention. Results: in GI the intervention to maintain stable knowledge level about pre-diabetes, and decrease triglycerides level was effective. The model did not exceed usual care for decrease in weight, waist circumference, glucose and cholesterol.

Evaluación de programa piloto de apoyo para trabajadores que cuidan a familiares dependientes: estudio pre-postest / Evaluation of a pilot program for the support of family caregivers who work and care for dependent relatives: pre and posttest

El envejecimiento de la población aumenta la posibilidad de requerir cuidados, los cuales son proprocionados por las familias, especialmente por las mujeres. Para quienes tienen trabajo remunerado, significa cumplir un doble rol. Esto es un factor de riesgo para la salud del trabajador, la calidad del cuidado entregado y su rendimiento laboral. Objetivos: evaluar el efecto de programa piloto de apoyo a trabajadores que ejercen tareas de cuidado informal, sobre su percepción de carga de cuidado y de apoyo social. Métodos: estudio pre-postest, con 25 funcionarios que ejercen el doble rol de trabajador-cuidador informal. Resultados: la intervención demostró ser efectiva al disminuir la percepción de carga de cuidado y aumentar la percepción de apoyo social. Conclusión: intervenciones implementadas dentro del ámbito laboral y con el apoyo de la institución aportan a la percepción de apoyo de los trabajadores y a su satisfacción con el programa

The aging population increased the possibility of need to be care. Historically women have assumed this task adding it to those performed as paid workers. This dual role is a risk factor for the health of workers, quality of care delivery and job performance. Objectives: To evaluate the effect of intervention for workers who perform tasks of informal care on the perceived burden of care and social support program. Methods: A pre-post test study with 25 workers who wield dual role of informal caregivers. Conclusions: The intervention was effective to reduce the perceived burden of care and increase the perception of social support, which makes it highly recommended such interventions contributing to the health of workers and family caregiver

Validación de la Escala Rapid Assessment of Physical Activity (RAPA) en población chilena adulta consultante en Atención Primaria / Validation of the Rapid Assessment of Physical Activity Scale (RAPA) in an Adult Chilean Population Seeking Primary Care / Validação da escala Rapid Assessment of Physical Activity (Rapa) em população chilena idosa consultante em Atenção Primária

Introducción: la práctica de actividad física es esencial para el cuidado de la salud. Se requiere contar con instrumentos que permitan medirla y monitorear los cambios en las personas que la practican. Objetivos: adaptar culturalmente el cuestionario Rapid Assessment of Physical Activity (RAPA), y estimar sus propiedades psicométricas, su validez y confiabilidad, para medir el nivel de actividad física en personas adultas consultantes en centros de atención primaria en Santiago (Chile). Materiales y métodos: el RAPA adaptado fue aplicado a 180 adultos asistentes a 5 centros de salud. Se determinó su índice de masa corporal (IMC) y circunferencia de cintura (CC). Resultados: las puntuaciones en la escala RAPA se relacionaron en forma inversa y significativa con el perímetro de cintura y el IMC. Las personas categorizadas con bajo nivel de actividad física (Poco Activo y Poco Activo Regular Ligero) presentan un IMC promedio más elevado y son más frecuentemente categorizados con CC alterada. La confiabilidad del instrumento fue moderada (r = 0,61; K = 0,34). Conclusiones: el RAPA en su versión en español adaptada para Chile, es un instrumento de fácil aplicación, que pese a su moderada confiabilidad, logra ser sensible al desarrollo de actividad física, que presenta una relación coherente con los parámetros antropométricos de IMC y CC sensibles a dicha actividad.

Introduction: Physical activity is vital to health care and having instruments to measure and monitor changes in people who are physically active is essential. Objectives: Culturally adapt the Rapid Assessment of Physical Activity (RAPA) questionnaire and estimate its psychometric properties, validity and reliability as an instrument to measure the level of physical activity among adults seeking primary care at health centers in Santiago (Chile). Materials and Methods: The adapted RAPA was applied to 180 adults who were being treated at five health centers. Their body mass index (BMI) and waist circumference (WC) was determined. Results: The scores on the RAPA scale were inversely and significantly linked to waist circumference and BMI. Persons categorized as having low levels of physical activity (i.e., little activity and little regular light activity) have a higher BMI, on average, and are more often categorized with altered WC. The reliability of the instrument was moderate (r = 61; K = 0.34). Conclusions: The Spanish language version of the Rapid Assessment of Physical Activity (RAPA) questionnaire adapted for Chile is a user-friendly application. Despite being only moderately reliable, it is sensitive to the development of physical activity, which shows a coherent connection to the anthropometric parameters of BMI and WC that are sensitive to this kind of activity.

Introdução: a prática de atividade física é essencial para o cuidado da saúde. Requer-se contar com instrumentos que permitam medi-la e monitorar as mudanças nas pessoas que a praticam. Objetivos: adaptar culturalmente o questionário Rapid Assessment of Physical Activity (Rapa) e estimar suas propriedades psicométricas, sua validade e confiabilidade para medir o nível de atividade física em pessoas idosas consultantes em centros de atenção primária em Santiago (Chile). Materiais e método: o Rapa adaptado foi aplicado a 180 idosos frequentadores de cinco unidades de saúde. Determinou-se seu índice de massa corporal (IMC) e circunferência de cintura (CC). Resultados: as pontuações na escala Rapa se relacionaram em forma inversa e significativa com o perímetro de cintura e o IMC. As pessoas categorizadas com baixo nível de atividade física (pouco ativo e pouco ativo regular leve) apresentaram um IMC médio mais elevado e são mais frequentemente categorizadas com CC alterada. A confiabilidade do instrumento foi moderada (r = ,61; K = 0,34). Conclusões: o Rapa em sua versão em espanhol adaptada para o Chile é um instrumento de fácil aplicação, que, mesmo com sua moderada confiabilidade, consegue ser sensível ao desenvolvimento da atividade física, que apresenta uma relação coerente com os parâmetros antropométricos de IMC e CC sensíveis a essa atividade.

[Pilot plan for a mobile health communication and monitoring system for people with diabetes]. / Plan piloto del sistema de comunicación y seguimiento móvil en salud para personas con diabetes.

mHealth is a practical, useful, and available tool for one-way or two-way communication between health professionals and patients. It is especially promising in countries such as Chile, with widespread and growing mobile telephone coverage that is very well accepted by the public. Our objective is to demonstrate the process for designing a mobile communication and monitoring model, aimed at providing communication between professionals in primary healthcare centers and their patients, to facilitate timely diagnosis and initiation of treatment for type 2 diabetes. This model's characteristics include use of mobile telephones as a communication tool, a one-way method (from health centers to patients), integration into in-person care delivered at health centers, use of different communication strategies (voice and written), and integrated functioning using open-source software. The system includes personalized communication, automated voice communication, and automated written communication using short message service (SMS). We describe the strategies and components of the system. The lessons learned include the contribution from successful implementation of COSMOS (consolidated online modulated operating systems), a technological innovation, to support the health care of people with suspected type 2 diabetes in primary healthcare centers. Working together with teams in the field is essential to this achievement.

Plan piloto del sistema de comunicación y seguimiento móvil en salud para personas con diabetes / Pilot plan for a mobile health communication and monitoring system for people with diabetes

La mSalud es una herramienta práctica, útil y disponible para la comunicación unidireccional o bidireccional entre profesionales de la salud y el paciente, cuyo uso es especialmente promisorio en países como Chile, con una amplia y creciente cobertura de telefonía móvil muy bien aceptada por la población. Nuestro objetivo es mostrar el proceso de diseño de un modelo de comunicación y seguimiento móvil, destinado a facilitar la comunicación entre profesionales de los centros atención primaria en salud y sus usuarios, para lograr el diagnóstico oportuno e inicio del tratamiento de la diabetes mellitus de tipo 2 (DM2). Este modelo se caracteriza por utilizar el teléfono móvil como herramienta de comunicación, ser un método unidireccional (desde los centros de salud hacia los usuarios), estar integrado con la atención presencial que se entrega en los centros de salud, utilizar diferentes estrategias de comunicación (vía voz y escrita), y funcionar integrado en un software diseñado en código abierto. El sistema incluyó la implementación de comunicación personalizada, comunicación automatizada de voz y comunicación automatizada escrita a través de servicio de mensaje corto de voz. Se describen estas estrategias y los componentes del sistema. Entre las lecciones aprendidas, se destaca el aporte de lograr implementar la innovación tecnológica COSMOS (sistemas operadores modulados consolidados en línea, por su sigla en inglés), para apoyar el proceso de cuidado de la salud de las personas con sospecha de DM2 en centros de atención primaria de salud. Para este logro, resulta imprescindible el trabajo conjunto con los equipos en terreno.

mHealth is a practical, useful, and available tool for one-way or two-way communication between health professionals and patients. It is especially promising in countries such as Chile, with widespread and growing mobile telephone coverage that is very well accepted by the public. Our objective is to demonstrate the process for designing a mobile communication and monitoring model, aimed at providing communication between professionals in primary healthcare centers and their patients, to facilitate timely diagnosis and initiation of treatment for type 2 diabetes. This model's characteristics include use of mobile telephones as a communication tool, a one-way method (from health centers to patients), integration into in-person care delivered at health centers, use of different communication strategies (voice and written), and integrated functioning using open-source software. The system includes personalized communication, automated voice communication, and automated written communication using short message service (SMS). We describe the strategies and components of the system. The lessons learned include the contribution from successful implementation of COSMOS (consolidated online modulated operating systems), a technological innovation, to support the health care of people with suspected type 2 diabetes in primary healthcare centers. Working together with teams in the field is essential to this achievement.

Validación inicial de un instrumento de análisis del apoyo a la toma de decisiones para el manejo de enfermedades crónicas / Initial Validation of an Analytical Tool to Support Decision-making on Chronic Illness Management / Validação inicial de um instrumento de análise do apoio na tomada de decisões para o manejo de doenças crônicas

Introducción: el apoyo a la toma de decisiones en salud facilita el automanejo de personas con enfermedades crónicas (EC). Objetivo: validar la versión en español del DSAT-cdm: herramienta de análisis del apoyo en las decisiones para el manejo de EC, desarrollada por Stacey (2006). Materiales y métodos: estudio descriptivo que aplica un proceso sistemático que considera, entre otros: traducción-contratraducción, desarrollo de escenarios de simulación, entrenamiento de evaluadores, entrenamiento pacientes simulados y capacitación para participantes. Muestra: 15 profesionales y 2 jueces, obteniéndose 60 DSAT-cdm versión español aplicado (pre y pos capacitación). Resultados: el instrumento presentó confiabilidad aceptable en la aplicación entre-jueces y detectó la mejora en la calidad del apoyo a la toma de decisiones en los profesionales. Sin embargo, no se obtuvieron resultados que aportaran a la validez de criterio concurrente. Conclusiones: este estudio es la primera evaluación del DSAT-cdm en idioma español, el resultado principal indica que se detecta un cambio en el desempeño de profesionales para apoyar el proceso de toma de decisiones de sus pacientes y, a pesar estos hallazgos favorables, es necesario seguir evaluando el instrumento.

Introduction: Support for decision-making in health facilitates self-management by persons with chronic illness (CI). Objective: Validate the Spanish- language version of DSAT - cdm: an analytical tool developed by Stacey (2006) to support decision-making on CI management. Materials and Methods: This descriptive study applies a systematic process that considers a number of aspects, such as translation - back-translation, simulation scenario development, training evaluators, simulated patient training and training for participants. Sample: 15 professionals and two judges, obtaining 60 DSAT - cdm with the applied Spanish version (pre and post training). Results: The instrument showed acceptable reliability in application among judges and found improvement in the quality of decision-making support on the part of professionals. However, no results were obtained that contribute to concurrent criterion validity. Conclusions: This study is the first assessment of DSAT - cdm in Spanish. The main result indicates a change is detected in the performance of professionals to support the decision-making process of their patients. Yet, despite this favorable finding, further evaluation of the instrument is necessary.

Introdução: o apoio na tomada de decisões em saúde facilita o automanejo de pessoas com doenças crônicas (ec em espanhol). Objjetivo: validar a versão em espanhol do DSTA-cdm: ferramenta de análise do apoio nas decisões para o manejo de ec, desenvolvida por Stacey (2006). Materiais e métodos: estudo descritivo que aplica um processo sistemático que considera, entre outros: tradução-contratradução, desenvolvimento de cenários de simulação, treinamento de avaliadores, treinamento de pacientes simulados e capacitação para participantes. Amostra: 15 profissionais e 2 juízes, com obtenção de 60 dsat-cdm versão espanhol aplicado (pré e pós capacitação). Resultados: o instrumento apresentou confiabilidade aceitável na aplicação entre juízes e detectou a melhoria na qualidade do apoio na tomada de decisões nos profissionais. Contudo, não se obtiveram resultados que contribuíssem para a validade de critério concorrente. Conclusões: este estudo é a primeira avaliação do dsat-cdm em espanhol; o resultado principal indica que se detecta uma mudança no desempenho de profissionais para apoiar o processo de tomada de decisões de seus pacientes e, apesar dessas descobertas favoráveis, é necessário continuar avaliando o instrumento.

Shared decision making in Chile: supportive policies and research initiatives.

WHAT ABOUT POLICY REGARDING SDM? Since 1999, there has been a small but growing interest by academics, the government, and society as a whole in strengthening patients' and professionals' involvement in shared decision making (SDM). Two governmental policy documents that indicate support for SDM are (1) Health Reform in 2003 and (2) Sanitary Objectives 2011-2020, which includes a brief section on client participation and SDM. WHAT ABOUT TOOLS - DECISION SUPPORT FOR PATIENTS? Research by Chilean academics has highlighted the patients' desire to participate in health decisions and effective approaches for enhancing health professionals' skills in interprofessional SDM; however, little has been done to support this need and the work is centralised in only one academic institution. Decision support tools and coaching interventions are limited to patients considering decisions about managing type 2 diabetes. WHAT ABOUT PROFESSIONAL INTEREST AND IMPLEMENTATION? Although there is increasing attention to studying patients' participation and involvement on their healthcare, little has been studied in relation to professionals' interest in SDM. As well, there are significant challenges for implementation of a country-wide SDM policy. WHAT DOES THE FUTURE LOOK LIKE? The future looks promising given the new health policies, local Chilean research projects, and international initiatives. Collaboration between health professionals, academics, and government policy makers, with public involvement needs to be strengthened in order to promote concrete strategies to implement SDM in Chile.

[Effect of a tele-care model on self-management and metabolic control among patients with type 2 diabetes in primary care centers in Santiago, Chile]. / Efecto de un modelo de apoyo telefónico en el auto-manejo y control metabólico de la Diabetes tipo 2, en un Centro de Atención Primaria, Santiago, Chile.

BACKGROUND: Telephone based self-management support may improve the metabolic control of patients with type2 (DM2) diabetes if it is coordinated with primary care centers, if telephone protocols and clinical guidelines are used and if it is provided by nurses trained in motivational interviewing. AIM: To assess the efficacy of a tele-care self-management support model (ATAS) on metabolic control of patients with DM2 attending primary care centers in a low income area in Santiago, Chile. MATERIAL AND METHODS: Two primary care centers were randomly assigned to continue with usual care (control group, CG) or to receive additionally 6 telecare self-management support interventions (IG) during a 15 month period. Glycosylated hemoglobin (HbA1c) was used to measure metabolic control of DM2; the "Summary of Diabetes Self-care Activities Measure" and the "Spanish Diabetes Self-efficacy" scale were used to measure self-management and self efficacy, respectively. Changes in the use of health services were also evaluated. RESULTS: The IG maintained its HbA1c level (baseline and final levels of 8.3 +/- 2.3% and 8.5 +/- 2.2% respectively) whereas it deteriorated in the CG (baseline and final levels of 7.4 +/- 2.3 and 8.8 +/- 2.3% respectively, p < 0.001). The perception of self-efficacy in the IG improved while remaining unchanged in the CG (p < 0.001). Adherence to medication, physical activity and foot care did not change in either group. In the IG, compliance to clinic visits increased while emergency care visits decreased. CONCLUSIONS: The ATAS intervention, in low income primary care centers, significantly increased the probability of stabilizing the metabolic control of patients with DM2 and improved their use of health services.

Efecto de un modelo de apoyo telefónico en el auto-manejo y control metabólico de la Diabetes tipo 2, en un Centro de Atención Primaria, Santiago, Chile / Effect of a tele-care model on self-management and metabolic control among patients with type 2 diabetes in primary care centers in Santiago, Chile

Background: Telephone based self-management support may improve the metabolic control of patients with type 2 (DM2) diabetes if it is coordinated with primary care centers, if telephone protocols and clinical guidelines are used and if it is provided by nurses trained in motivational interviewing. Aim: To assess the efficacy ofi a tele-care self-management support model (ATAS) on metabolic control of patients with DM2 attending primary care centers in a low income area in Santiago, Chile. Material and Methods: Two primary care centers were randomly assigned to continue with usual care (control group, CG) or to receive additionally 6 telecare self-management support interventions (IG) during a 15 month period. Glycosylated hemoglobin (HbA1c) was used to measure metabolic control of DM2; the “Summary of Diabetes Self-care Activities Measure” and the “Spanish Diabetes Self-efficacy” scale were used to measure self-management and self efficacy, respectively. Changes in the use of health services were also evaluated. Results: The IG maintained its HbA1c level (baseline and final levels of 8.3 ± 2.3 percent and 8.5 ± 2.2 percent respectively) whereas it deteriorated in the CG (baseline and final levels of 7.4 ± 2.3 and 8.8 ± 2.3 percent respectively, p < 0.001). The perception of self-efficacy in the IG improved while remaining unchanged in the CG (p < 0.001). Adherence to medication, physical activity and foot care did not change in either group. In the IG, compliance to clinic visits increased while emergency care visits decreased. Conclusions: The ATAS intervention, in low income primary care centers, significantly increased the probability of stabilizing the metabolic control of patients with DM2 and improved their use of health services.

[Innovative care and self-care strategies for people with chronic diseases in Latin America]. / Estrategias innovadoras para el cuidado y el autocuidado de personas con enfermedades crónicas en América Latina.

OBJECTIVES: To identify innovative strategies for improved care and self-care of patients with chronic diseases (CD) in Latin America and to explore interest in creating a Latin American network of professionals in this field. METHODS: A descriptive study based on a survey of key experts with recognized national or regional leadership in CD patient care. The 25-question questionnaire sought information on their experiences with care and self-care initiatives for CD patients, descriptions of successful initiatives, the perceived ability of countries to innovate in this area, their interest in participating in a network of Latin American professionals in this field, and more. Content analysis was performed to develop recommendations for the Region. RESULTS: Responses were obtained from 17 (37.8%) of the 45 experts approached; 82.4% confirmed their knowledge of of involvement with an innovative initiative related to the subject. Initial development does exist in each of the three innovative strategy types: peer care, informal caregivers, and telenursing, the latter being the least explored. There is real interest in forming a Latin American network that focuses on development of innovative self-care strategies for CD patients. CONCLUSIONS: Support for a joint network is promising. Priorities are building skills in this area and developing innovative proposals for improved CD patient care in the Region. Innovative measures should be complementary and adapted to the specific context of each scenario.

Estrategias innovadoras para el cuidado y el autocuidado de personas con enfermedades crónicas en América Latina / Innovative care and self-care strategies for people with chronic diseases in Latin America

OBJETIVOS: Identificar estrategias innovadoras dirigidas a mejorar el cuidado y el autocuidado de los pacientes con enfermedades crónicas (EC) en América Latina y explorar el interés en crear una red latinoamericana de profesionales en ese campo. MÉTODOS: Estudio descriptivo exploratorio basado en una encuesta aplicada a expertos clave con reconocido liderazgo nacional o regional en la atención de pacientes con EC. El cuestionario de 25 preguntas recababa información sobre su experiencia en iniciativas de cuidado y autocuidado de pacientes con EC, la descripción de las iniciativas exitosas, la percepción de la capacidad de los países para innovar en este ámbito y el interés en participar en una red de profesionales latinoamericanos en ese campo, entre otras. Se realizó un análisis de contenidos para elaborar recomendaciones para la Región. RESULTADOS: Se obtuvo respuesta de 17 (37,8 por ciento) de los 45 expertos invitados; 82,4 por ciento afirmó conocer o participar en alguna iniciativa innovadora en el tema planteado. Existe un incipiente desarrollo de los tres tipos de estrategias innovadoras: cuidado por pares, cuidadores informales y telecuidado, esta última es la menos explorada. Hay un real interés en conformar una red latinoamericana para el desarrollo de estrategias innovadoras dirigidas al autocuidado de pacientes con EC. CONCLUSIONES: Las bases para una red de trabajo conjunto son promisorias y es prioritario fortalecer las competencias en esta área y desarrollar propuestas innovadoras para mejorar la atención de los pacientes con EC en la Región. Las medidas innovadoras deben ser complementarias y se deben ajustar al contexto específico de cada escenario.

OBJECTIVES: To identify innovative strategies for improved care and self-care of patients with chronic diseases (CD) in Latin America and to explore interest in creating a Latin American network of professionals in this field. METHODS: A descriptive study based on a survey of key experts with recognized national or regional leadership in CD patient care. The 25-question questionnaire sought information on their experiences with care and self-care initiatives for CD patients, descriptions of successful initiatives, the perceived ability of countries to innovate in this area, their interest in participating in a network of Latin American professionals in this field, and more. Content analysis was performed to develop recommendations for the Region. RESULTS: Responses were obtained from 17 (37.8 percent) of the 45 experts approached; 82.4 percent confirmed their knowledge of of involvement with an innovative initiative related to the subject. Initial development does exist in each of the three innovative strategy types: peer care, informal caregivers, and telenursing, the latter being the least explored. There is real interest in forming a Latin American network that focuses on development of innovative self-care strategies for CD patients. CONCLUSIONS: Support for a joint network is promising. Priorities are building skills in this area and developing innovative proposals for improved CD patient care in the Region. Innovative measures should be complementary and adapted to the specific context of each scenario.