Emilio Gutiérrez Calderón’s research while affiliated with National Autonomous University of Mexico and other places

The Mexican Institute of Social Security (IMSS) is strengthening diabetes care through piloting the Chronic Disease Preventive Model (CDPM) that includes intensive diabetes education, interdisciplinary care teams, and intensification of insulin therapy and of HbA1c monitoring. To address CDPM implementation challenges, we analyzed care bottlenecks and facilitators and barriers in the internal and external institutional contexts.The CDPM planning process is facilitated by clinical protocols, role redefinition, and an incremental approach to implementation. However, the overly large size of IMSS together with its verticality, excessive bureaucratic control, and limitation of autonomy at the primary care level restrain staff motivation, coordination, and the alignment of interests along the innovation value chain. CDPM implementation faces weak support by governance at the highest levels within IMSS while patients expect IMSS to be a provider of medications rather than to be a partner in the provision of comprehensive care.For CDPM to be fully implemented, IMSS would have to increase by 16.2% the total number of family physicians while increasing by more than 1000% the number of professionals in clinical psychology and nutrition. CDPM would require a 335% increase in diabetes care spending, mostly for increased insulin treatment and human resources. Spending for diabetes would have to increase from the current 14.3% of total health spending to 20.6%. Spending on diabetes-related complications, however, would decrease.Reforms should be developed with universities, professional associations, and the IMSS workers’ trade union as well as with the pharmaceutical industry to ensure breakthroughs in new professional and technical profiles and less costly pharmaceuticals. Reforms should be supported on digital innovation to reduce treatment costs while improving adherence, quality of care, monitoring, and evaluation. Reforms should include a national diabetes care policy to empower persons living with diabetes.KeywordsDiabetes care innovation challengesMexico

Background. Monitoring of SARS-COV-2 vaccine hesitancy is important for epidemic control. We measured vaccine hesitancy among healthy adults and adults with chronic diseases after they had been offered the first dose of the vaccine in Mexico City. Methods. An observational cross-sectional study was undertaken among 185 healthy adults and 175 adults living with chronic diseases. Differences in means of variables for confidence, complacency, and convenience were analyzed. Aggregate indicators were constructed and their association to socioeconomic and demographic conditions and to vaccination acceptance were analyzed using multivariate analysis of variance and multivariate logistic analysis. Results. Up to 16.8% of healthy adults and 10.3% of sick adults report not having received the SARS-COV-2 vaccine. Healthy adults are more complacent about COVID-19 risks than adults with chronic diseases, while no differences were reported across the two groups regarding other hesitancy aggregate indicators. Among adults with chronic diseases, those with more education and enrolled with a social insurance institution are less complacent of COVID-19, while education is positively associated to convenience across both groups. Less complacency with COVID-19 and more confidence on the vaccine are associated to higher vaccine acceptance across both groups. Among adults living with chronic diseases the odds ratios of vaccine acceptance are higher for less complacency (OR=2.4, p=0.007) than for confidence (OR=2.0, p=0.001). Odds ratios of vaccine acceptance in these two hesitancy indicators are similar among healthy adults (OR=3.3, p=<0.005), and higher than for adults with comorbidities. Conclusions. Confidence in the vaccine and complacency regarding COVID-19 risks play an important role for vaccine acceptance in Mexico City, particularly among healthy adults. The perception of risk regarding COVID-19 is more important than confidence in vaccine safety and effectiveness. Promotion of COVID-19 vaccines needs to focus on decreasing complacency with COVID-19 and increasing vaccine confidence, particularly among healthy adults.

Background 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. Methods 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). Results 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 institute 38.1% have HbA1c levels below 7% and 26.1% have levels above 9%. CDPM facilitators are the perceived threat of uncontrolled diabetes, compatibility of innovation values and willingness for institutional learning. Barriers are centralized decision making, functional differentiation across managers and practitioners and lack of incentives, resource shortages and the lack of measures to ensure fidelity. Conclusions CDPM scale-up has to address organizational and process barriers while ensuring the necessary resources for sustainability.

Background: Scientific journals play a critical role in research validation and dissemination and are increasingly vocal about the identification of research priorities and the targeting of research results to key audiences. No new journals specialising in health policy and systems research (HPSR) and focusing in the developing world or in a specific developing world region have been established since the early 1980s. This paper compares the growth of publications on HPSR across Latin America and the world and explores the potential, feasibility and challenges of innovative publication strategies. Methods: A bibliometric analysis was undertaken using HPSR MeSH terms with journals indexed in Medline. A survey was undertaken among 2500 authors publishing on HPSR in Latin America (LA) through an online survey, with a 13.1% response rate. Aggregate indicators were constructed and validated, and two-way ANOVA tests were performed on key variables. Results: HPSR publications on LA observed an average annual growth of 27.5% from the years 2000 to 2018, as against 11.4% worldwide and yet a lag on papers published per capita. A total of 48 journals with an Impact Factor publish HPSR on LA, of which 5 non-specialised journals are published in the region and are ranked in the bottom quintile of Impact Factor. While the majority of HPSR papers worldwide is published in specialised HPSR journals, in LA this is the minority. Very few researchers from LA sit in the Editorial Board of international journals. Researchers highly support strengthening quality HPSR publications through publishing in open access, on-line journals with a focus on the LA region and with peer reviewers specialized on the region. Researchers would support a new open access journal specializing in the LA region and in HPSR, publishing in English. Open access up-front costs and disincentives while waiting for an Impact Factor can be overcome. Conclusion: Researchers publishing on HPSR in LA widely support the launching of a new specialised journal for the region with a vigorous editorial policy focusing on regional and country priorities. Strategies should be in place to support English-language publishing and to develop a community of practice around the publication process. In the first years, special issues should be promoted through a priority-setting process to attract prominent authors, develop the audience and attain an Impact Factor.