The rationale for integrated care deployment to chronic patients in Ecuador and proposals to act locally: results from a mixed method study

Abstract

Integrated care (IC) has potential to improve health care experience and treatment adherence by properly coordinated and stratified care. We aimed to: (i) assess the patients’ perception about the degree of integrality in their care, (ii) identify potential predictors for risk assessment; and, (iii) assess clinicians’ and patients’ expectations about the involvement of general practitioners (GP) specialists in chronic care. Methods: mixed methods study. Cross sectional study: Two subsets of chronic patients (total n=416) attended by three public health care centres in Portoviejo – Ecuador were studied. In first subset (n=111) we searched for independent associations between sociodemographic and clinical variables with perception of integrality in their care by Patient Assessment of Care for Chronic Conditions (PACIC) instrument. In second subset (n=305), we searched for independent associations between clinical data –collected by “the passport to a healthy lifestyle”–, BMI, diagnoses, and self-rated health with: (i) representations of illness by the Brief Illness Perception Questionnaire (BIPQ) questionnaire, and (ii) any hospitalization in last year. Qualitative research: Two focus groups, focused on finding out expectations of future involvement of GP specialists in chronic care, subsequent transcription and discursive analyses were performed. Results: Patients were, mostly, female, median age of 59 years old, low educated, married, unemployed, and without social security. First subset: median (P25 to P75) PACIC score was 4 (3.2 to 4.8) points, ageing, male sex and longer duration of the disease were associated with a lower PACIC score. Second subset: ageing, low education, and unemployment were associated with lower BIPQ score. Abnormal BMI, fair to poor self-rated health, and multimorbidity were associated to any hospitalization in last year (aOR=2.8, 95%CI: 1.0 to 8.0; aOR=2.3, 95%CI: 1.0 to 5.9; and, aOR=2.5, 95%CI: 1.1 to 5.8, respectively). Physicians and patients considered that there is scarce or poor integrality in chronic care and that IC is necessary; further, involvement of GP specialists is seen as it would improve chronic care.