Browsing by Author "Martínez Pérez, Mayra Alicia"

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    An innovative multimorbidity patient-centered care model in Chile: implementation evaluation results
    (Springer Nature, 2025) Sapag Muñoz de la Peña, Jaime; Martínez Pérez, Mayra Alicia; Zamorano Pichard, Paula Francisca; Varela Yuraszeck, Teresita Inés; Muñoz, Paulina; Seguel Araus, Romina Javiera; Irazoqui Soto, Esteban; Tellez, Alvaro
    Background The impact of non-communicable diseases and multimorbidity challenges health systems worldwide. Latin America faces an urgent need to develop practical innovations in that regard. The Centro de Innovación en Salud ANCORA UC implemented a new Multimorbidity Patient-Centered Care Model (MPCM) pilot in Chile between 2017 and 2020. MPCM aimed to reorganize health services from a fragmented diagnosis-based perspective towards a new approach based on patient’s needs and offer intervention strategies according to their multimorbidity risk. This article aims to report the evaluation of the implementation process of MPCM in the Southeast Metropolitan Health District in Chile. Methods The study design corresponds to an implementation collaborative evaluation of MPCM innovation using qualitative methodology. Two main questions guided the research: (1) How has MPCM been implemented in its pilot phase? Moreover, (2) What are the main learnings from the MPCM pilot phase and their contribution to its scalability at the national level? In addition, the Consolidated Framework for Implementation Research and the Outcomes for Implementation Research were considered in the theoretical approach. Results Thirty-five (35) interviews were conducted with 69 professionals and key stakeholders involved in the implementation process of MPCM, including health practitioners, transition nurses who coordinate the intervention with the affiliated hospitals, managers, and the implementation team. Overall, the results were positive, suggesting that a complex innovation of this kind may be implemented successfully. Key lessons learned should be considered for scaling up MPCM to the national level. Some critical barriers to implementation were high staff turnover and the COVID-19 pandemic, while leadership and team commitment were relevant facilitators. Conclusions This study represents a new step in evaluating an innovative model for addressing multimorbidity in Chile. The scaling up phase requires careful consideration of all lessons learned, as well as a robust evaluation and monitoring plan. This research represents the first evaluative analysis of MPCM in the context of a complex innovation adapted to enhance public health policies using implementation evaluation approaches. Implementation Science is a fundamental approach to fostering quality improvement strategies for health care in Latin America.
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    Evaluation of patients´ perspective on a multimorbidity patient-centered care model piloted in the chilean public health system
    (2023) Sapag Muñoz de la Peña, Jaime; Martínez Pérez, Mayra Alicia; Zamorano, Paula; Varela, Teresita; Téllez, Álvaro; Irazoqui Soto, Esteban; Muñoz C., Paulina
    Background The progressive multimorbidity explosion has challenged Chile’s health systems and worldwide. The Centro de Innovación en Salud ANCORA UC implemented a new Multimorbidity Patient-Centered Care Model in Chile. Objective Evaluate the perspective of high-risk patients about the core elements of the model. Methodology We conducted a cross sectional telephone-based survey that considered the application of a 13 items questionnaire. Of them, nine were Likert scale questions with scores from 1 to 7, one dichotomic question, and three open-ended questions. 231 high-risk patients who received care through the model at primary care centers participated in the study. Quantitative data were encoded, consolidated, and analyzed with the SPSS software. We performed descriptive and analytic statistics techniques to assess different variables and their potential associations. Thematic analysis was conducted for qualitative data. Results The overall score was 5.84 (range: 1 to 7), with a standard deviation of 1.25. Questions with the best scores were those related with personalized care and the primary care teams. The lowest scored was for the item regarding the continuity of care between primary nurses and inpatient care at the hospital. There was a difference in patient outcomes depending on their health center. Regarding sociodemographic characteristics, age did not significantly affect the results. Conclusions The study reveals the perceptions about a complex multimorbidity intervention from the patient’s perspective. It complements the impact on health services utilization evaluation that supports decision-makers currently scaling up a similar strategy in our country and could be considered in other countries dealing with non-communicable diseases.
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    Mixed-methods evaluation of the initial implementation of advanced home visits in Chile
    (2022) García-Huidobro Munita, Diego Nicolás; Vergés, Álvaro; Basualto, Patricia; Calvo Miranda, Carlos; Boetto Puebla, Carolina; Soto, Mauricio; Kopplin Ibáñez, Erika Blanca; Martínez Pérez, Mayra Alicia; Aracena Álvarez, Marcela
    Home visiting programs are evidence-based interventions that have a myriad outcomes for mothers and newborns. Chile offers these services as part of the Chile Crece Contigo, a nationwide program. However, implementing home visiting programs in community settings is difficult. In this study, we report clinic, provider, and participant engagement with the implementation of advanced home visits (ViDAs) in Chilean primary care clinics. ViDAs include a high number of visits, external supervision, and the use of technology. In this study, qualitative and quantitative data were collected to assess the initial implementation of the home visiting strategy. Qualitative data consisted of individual interviews and focus groups with directors of city health departments, clinic managers, and providers conducting home visits. Quantitative data included clinic, provider, and participant recruitment. City health departments were approached to authorize the participation of primary care clinics in the ViDAs program. Then, clinic directors were invited to approve the implementation of the home visiting program at their health centers. In total, 16 clinics, 42 practitioners, and 185 participants were recruited. A large amount of resources was needed to recruit clinics, providers, and participants. The intervention had low acceptability, low adoption, and a high implementation cost. Initial program implementation experienced several challenges. Identified facilitators and barriers both highlighted the need for community engagement at all levels for the successful implementation of an innovation in Chilean primary care clinics. In addition, this article provides recommendations for practitioners and researchers regarding the conduct of research in community-based settings.
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    Performance of a national primary care chronic disease screening strategy in Chile: a mixed-methods analysis
    (2025-08-20) Zamorano, Paula; Varela Yuraszeck, Teresita Inés; Salvatierra Matzner, Isidora; Téllez, Álvaro; Martínez Pérez, Mayra Alicia; Ilabaca, Juan; Huidobro, Diego G.
    Introduction The continuous increase in chronic non-communicable diseases requires strengthening primary care preventive strategies. In Chile, preventive health screening is a national strategy focused on identifying adults with risk factors, including hypertension, diabetes, and dyslipidemia, among others. It is broadly implemented in primary care and has associated performance resources. Objective To evaluate the performance of Chile’s primary care preventive health screening for adults and describe healthcare professionals' perceptions regarding its implementation. Methods: A parallel convergent mixed-methods study was conducted. The quantitative component employed a retrospective cohort study to assess individuals between 15 and 64 years old who received a preventive health screening in primary care during 2023. Data analysis focused on access and waiting times of the screening pathways. The qualitative component consisted of an online survey to evaluate participants' perceptions of the screening pathways' performance. Results A total of 36,207 adult individuals received a preventive health screening during 2023, of which 61.5% were reported as completed. Screenings with the highest completion rates (between 99% and 80.1%) were those performed during the check-up day: high blood pressure, overweight and obesity, alcohol consumption, and smoking. Access to the second and third steps declines abruptly, with rates between 61.4% and 39.3%, including breast and cervical cancer screenings. The lowest access was to dyslipidemia and diabetes mellitus type two screening. Mean waiting times range from 16 to 179 days. The shortest times were from the screening to the first measure of the high blood pressure study and the pap smear test (16 and 18 days, respectively). The longest times were for diagnostic cardiovascular diseases (129 to 179 mean days). Qualitative findings identified that providers perceived that individuals are frequently lost when the screening pathway requires multiple steps, and highlighted the need to develop screening pathway protocols and implement strategies to manage the screening pathway proactively. Conclusion This is the first evaluation of Chile’s preventive health screening, demonstrating high implementation but dramatically low completion rates of diagnostic actions after the screening. The policy urgently needs to ensure active follow-up throughout the diagnostic pathway, which can lead to early diagnosis and prevent avoidable complications of cardiovascular disease and cancer.