The Dominican Republic is using a self-care model to improve the quality of care and health of people with chronic illnesses.
Dominican Republic, 11 November, 2015 (PAHO/WHO)- Diabetes affects 10% of Dominicans over 18 years of age, including Mayeli Benítez Morán, who has been living with diabetes for eight years. She was only 20 years old when she was diagnosed at the La Pared de Haina health center, half an hour from Santo Domingo, the capital of the Dominican Republic.
Mayeli studies architecture and takes care of her home, husband, and 5-year-old son. She also takes care of her health with a healthy diet, regular physical activity, visits to her doctor, diabetes control, and self-administered insulin.
To keep track of her monitoring, she uses the Passport to Healthy Lifestyle, a sort of logbook developed by the Pan American Health Organization/World Health Organization (PAHO/WHO) where people can record the results of each medical visit and the drugs included in their treatment. The passport also offers recommendations on nutrition and physical activity.
"The passport helps me monitor my medical appointments and also my diet, because it includes a list of foods I can eat," says Mayeli. The young woman is one of 40,000 people in the Dominican Republic who have received this tool to help them self-manage their disease. Nineteen other countries in the Americas also use the passport.
A personalized care model
The passport is part of the chronic care model implemented by the Dominican Republic in 2012. Developed by the MacColl Center and adapted by PAHO/WHO for use in other countries of the Americas, the model proposes integrated care to address chronic diseases.
Under this model, patients with diabetes, hypertension, or other chronic ailments are provided with personalized monitoring and timely, continuous care that can prevent or delay complications leading to disability and premature death.
In 2012, with the support of PAHO/WHO, Mayeli's home province of San Cristóbal became the first in the country to implement this model in its 80 primary care units. According to official data, around 80% of patients with diabetes who visit these units have filled out their disease control card, and there is now greater participation in support groups created to promote self-care.
"This model has helped improve the quality of care for chronic patients," said Dr. Tomiris Estepan, director of the Noncommunicable Chronic Diseases Program at the Ministry of Health of the Dominican Republic. "We used to provide reactive care, without real monitoring. We now have more comprehensive monitoring and proactive consultation, where physicians know what their patients need, put them into support groups, recommend physical activity, and, if the patients don't make an appointment, visit them at home," she explained.
Extending chronic care in the Americas
Noncommunicable diseases are the leading cause of death in the Americas. Some 61 million people live with diabetes in the Region, a number that continues to rise and is linked with the obesity epidemic. Depending on the country, an estimated 40-70% of people with diabetes do not achieve their disease control objectives.
Since 2009, PAHO/WHO has provided training in the chronic care model to officials of the ministries of health and to health workers in 33 countries of the Americas. Argentina, Brazil, Chile, Colombia, Costa Rica, Guatemala, Mexico, Nicaragua, and Paraguay are among the 27 countries that have documented 81 experiences using the model.
"This model has demonstrated benefits not only for people with diabetes and other chronic diseases, but also for countries' budgets. By reducing the number of hospitalizations due to complications from these diseases, the cost of care is reduced," said Dr. Alberto Barceló, PAHO/WHO regional advisor on diabetes.
Recognizing these benefits, the Dominican Republic has developed a program to update primary care physicians on the subject of chronic disease management. There are plans to extend the model to the second level of care in the future.