Barriers to hypertension and diabetes management in primary health care in Argentina: qualitative research based on a behavioral economics approach

BELIZAN, MARIA; ALONSO, JUAN P; NEJAMIS, ANALÍA; CAPORALE, JOAQUÍN; COPO, MARIANO G; SÁNCHEZ, MARIO; RUBINSTEIN, ADOLFO; IRAZOLA, VILMA

Translational Behavioral Medicine

Oxford University Press

Año: 2019

1869-6716

Despite efforts to improve detection and treatment of adultswith hypertension and diabetes in Argentina, many publichealthcare system users remain undiagnosed or face barriersin managing these diseases. The purpose of this study is toidentify health system, provider, and user-related factorsthat may hinder detection and treatment of hypertensionand diabetes using a traditional and behavioral economicsapproach. We did qualitative research using in-depthsemistructured interviews and focus groups with healthcareproviders and adult users of Public Primary Care Clinics. Healthsystem barriers included inadequate care accessibility; poorintegration between primary care clinics and local hospitals;lack of resources; and gender bias and neglect of adult chronicdisease. Healthcare provider?related barriers were inadequatetraining; lack of availability or reluctance to adopt ClinicalPractice Guidelines; and lack of counseling prioritization. From abehavioral economics perspective, bottlenecks were related toinertia and a status quo, overconfidence, and optimism biases.User-related barriers for treatment adherence included lack ofaccurate information; resistance to adopt lifelong treatment;affordability; and medical advice mistrust. From a behavioraleconomics perspective, the most significant bottlenecks wereoverconfidence and optimism, limited attention, and presentbiases. Based on these findings, new interventions that aim toimprove prevention and control of chronic conditions can beproposed. The study provides empirical evidence regardingthe barriers and bottlenecks in managing chronic conditionsin primary healthcare settings. Results may contribute to thedesign of behavioral interventions targeted towards healthcareprovision for the affected population.