[Strategy to improve access to etiological treatment of Chagas disease at the first level of care in Argentina].

Autor:	Klein K; Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina., Burrone MS; Programa Nacional de Chagas, Argentina., Alonso JP; Instituto de Investigaciones Gino Germani, Buenos Aires, Argentina., Ares LR; Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina., Martí SG; Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina., Lavenia A; Programa Provincial de Chagas, Tucumán, Argentina., Calderón E; Programa Nacional de Chagas, Argentina., Spillmann C; Programa Nacional de Chagas, Argentina., Estani SS; Instituto Nacional de Parasitología 'Dr. Mario Fatala Chabén', Administración Nacional de Laboratorios e Institutos de Salud, Ministerio de Salud. Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina.
Jazyk:	Spanish; Castilian
Zdroj:	Revista panamericana de salud publica = Pan American journal of public health [Rev Panam Salud Publica] 2017 May 25; Vol. 41, pp. e20. Date of Electronic Publication: 2017 May 25.
Abstrakt:	Objective: Improve distribution of etiological treatment of Chagas disease by identifying barriers to the decentralization of treatment to the first level of care in Argentina. Methods: A qualitative, exploratory, and descriptive study was conducted using semi-structured interviews of key actors belonging to the National Chagas Program and members of health teams at the first level of care, for the purpose of identifying barriers to diagnosis and treatment of Chagas disease at different levels (administrative, health agents, and community) that could affect a decentralized distribution strategy. Additionally, pilot decentralization was instituted in 10 primary health care centers in an Argentine province. Results: Semi-structured interviews were conducted with 22 program heads and health professionals. Principal obstacles found were lack of systematic case-finding, poor coordination among levels of care and health system actors, lack of health team training on treatment, patient monitoring, and patient-related barriers. A pilot decentralization program was carried out and strategies were evaluated to optimize large-scale intervention. Conclusions: The results made it possible to improve implementation of the plan to decentralize treatment through better inter-program coordination, capitalization on existing monitoring and communication tools, and sensitization of health teams. Furthermore, recommendations were developed to improve diagnosis and treatment of Chagas disease.
Databáze:	MEDLINE
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