Implementation Science in the Development of a Care Pathway for Chronic Chagas Disease: An Experience from a Municipality in Minas Gerais

TL;DR

This paper describes how implementation science helped create a care pathway for chronic Chagas disease in Brazil's primary health care system.

Contribution

The novel use of implementation science to adapt the Brazilian Chronic Care Model for Chagas disease care pathways in primary health care.

Findings

Implementation science effectively adapted the BCCM for Chagas disease care in primary health care.

Training 267 health professionals led to improved screening, testing, diagnosis, and treatment for Chagas disease.

The care pathway model may be replicated for other chronic diseases requiring longitudinal care.

Abstract

Chagas disease (CD) is a neglected endemic infectious disease. Primary health care (PHC) is responsible for delivering care to patients with CD in an integrated manner with other levels of the health system. We aimed to describe the use of implementation science (IS) as a tool for developing a care pathway for patients with CD from the perspective of the Brazilian Chronic Care Model (BCCM).

This study was conducted in the large municipality of Minas Gerais, Brazil. A diagnostic phase was conducted to identify barriers and facilitators related to CD care. The findings from this stage were analyzed using IS frameworks. Subsequently, the BCCM was adapted as a logical model to guide the creation of a care pathway. Health managers and professionals from the municipalities were trained to implement the proposed actions. After implementation, process and outcome indicators were monitored over a 12-month period.

IS proved to be an effective strategy for applying BCCM to patients with CD in PHC settings. A total of 267 health professionals were trained. After the intervention, the following indicators increased: risk factor screening, serological testing, diagnosis, and antiparasitic treatment for CD.

The development of a CD care pathway using IS tools integrated with the BCCM enabled the incorporation of processes into PHC and suggested that this model may be replicated in other contexts as well as for other chronic conditions requiring longitudinal care.

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