The CAMDI Team

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The CAMDI Team
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The CAMDI Team
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OUTLINE

• Show preliminary results of the Central America
  Diabetes Survey
• Results of quality of diabetes care survey in
  Central America
• Ongoing interventions aiming to improve the
  quality of diabetes care

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The health situation in Central America is
evolving from one in which the epidemiologic
profile is characterized by the predominance of
infectious diseases and disorders due to
nutritional deficiencies to one in which chronic
non communicable diseases (NCD) are prevalent.
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SURVEY OBJECTIVES

• Determine the prevalence of diabetes mellitus and
  hypertension in people 20 years of age and older
  in a sample taken from six Central American
  populations (urban areas of San Jose, Costa Rica
  San Salvador, El Salvador Guatemala City,
  Guatemala Tegucigalpa, Honduras and Managua,
  Nicaragua and the nationwide in Belize).
• Determine the prevalence of risk factors for
  diabetes and hypertension.

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DIAGNOSTIC CRITERIA

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10,822 men and women from a pool of pre selected
individuals of 13,138 participants from six
Central American populations were surveyed
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Participants were selected by random sampling in
multiple stages and stratified into three age
groups (20 to 39 years, 40 to 64 years, and 65 or
more years).
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The CAMDI Survey Sample
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Demographic characteristics () of participants,
the CAMDI Survey, 2002-2005
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Prevalence (, 95-CI) of different categories of
glucose intolerance by site, the CAMDI Survey
2002-2005
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Total Prevalence (, 95-CI) of DM by site, the
CAMDI Survey, 2002-2005
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Total prevalence (, 95-CI) of diabetes by
gender and site, the CAMDI Survey 2002-2005
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Crude and Standardized Prevalence (, 95-CI) of
Diabetes by site. The CAMDI Survey, 2002-2005
Standardized by the direct method using the US
2000 Census population as standard
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Proportion of participants () with diabetes
reporting the use of specific medication
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PHASE 2 The CAMDI Intervention
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Activities

• Three learning session in each participating
  country
• Training in diabetes education and foot care for
  health providers
• Diabetes education programs for patients
• Country and clinic specific activities responding
  to issues identified during LS
• Adaptation of educational material (manual,
  flipchart)
• Develop evidence based clinical guidelines for
  diabetes and hypertension in ES and HON
• Patients participate in LS

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Chronic care model
Organization of diabetes care
Clinical information system
Community linkages
Self management support
Delivery system design
Decision support
Prepared productive team
Informed activated patient
Productive interaction
Functional clinical outcomes
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Clinical chart review results
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Breakthrough Series for the Improvement of
Chronic Care (6 to 13 months time frame)
Participants
Select Topic (develop mission)
Prework
P
P
Develop Framework Changes
P
A
D
D
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S
S
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Planning Group
LS 2
LS 1
LS 3
FINAL
Support E-mail Visits Assessments
Telephone Monthly Team Reports
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First Learning Session in Guatemala
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INTERVENTION RESULTS FROM DEMONSTRATION SITES
IN MEXICO COSTA RICA
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Unexpected Positive Findings

• Stimulated the creation of health policies,
  cancer control plans and CA integration
• Creation of non related NCD quality of care
  programs (hypertension, A1c monitoring in CR,
  other diabetes quality of care improvement
  programs)
• Created NCD program in Guatemala and Honduras
• New medication added to the list of essential
  medicines

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Challenges

• Lack/low funding
• Slow implementation in some countries
• Political instability and leadership changes
  affected implementation
• Lack of coverage and shortage of some medicines
• Low capacity and interest of the PAHO office in
  some countries
• Required the development of tools and training

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Conclusions

• A population based diabetes survey motivated the
  creation of NCD-DM policies and programs in
  Central America
• The CAMDI survey demonstrated a high prevalence
  of diabetes
• The prevalence of diabetes was the highest among
  Belizean women
• The standardized prevalence of diabetes in the
  combined sampled populations of Central America
  was higher than that reported in the United States

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Conclusions

• The CAMDI survey and the quality of care studies
  identified gaps providing momentum for quality of
  diabetes care improvement programs
• Both the CAMDI survey and intervention influenced
  policy changes in the countries of Central
  America favoring improvement of access to
  services and medication

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