World status on implementation of the DAWN Call to Action and patient-centred initiatives in diabetes: Latin America

GAGLIARDINO JJ

Florencia, Italia

Workshop; 3rd International Dawn Summit. From practice and research to large scale implementation. Therapeutic Patient Education; 2006

By 2025, the World Health Organization estimates a 150% increase in diabetes in Latin America. Unless interventions to decrease such growth and the actual 65% of chronic complications are implemented, healthcare organisations will be unable to cope with the increased demand for diabetes care. Qualidiab (Latin American quality of diabetes care control programme) showed that: ·        Current care is a recovery/rehabilitation rather than a patient-centred preventive care model. ·        Although regional guidelines explicitly support the latter model, this is not widely implemented. Thus, few people with diabetes have regular access to health providers well-trained in delivering patient-centred diabetes care. ·        The team-care approach is only delivered in diabetes centres at secondary care level. ·        Education of people with diabetes, aimed at their empowerment and active participation in the control and treatment of their disease, is not a regular component of care. ·        Community-based strategies to prevent diabetes development in high-risk populations are not actively implemented. ·        Despite available validated tools, identification of psychosocial problems of people with diabetes is not widely used at every care level. Consequently, such problems are not systematically recorded and patient referral to diabetes psychologists is restricted to some health subsectors. ·        Patient-centred/psychosocial research in diabetes is scarce and low-funded. ·        There are few initiatives promoting the interaction between primary and secondary care level health providers to improve diabetes care in primary care settings. Feasible and effective patient-centred care models addressing the DAWN call to action have been implemented or are in progress in Argentina such as PRODIACOR*, which includes structured diabetes education for providers and patients and some DAWN-proposed tools.  Preliminary results showed improved outcomes and important economic savings. However, large scale implementation across Latin America remains a challenge whose success depends on a wide intersectorial commitment including research centres, healthcare professionals, governments, non-governmental and patient associations and the industry.