The Pan American chronic care observatory (pacco)

Introduction: Chronic disease management is one of the most pressing public health problems globally. The Region of Latin America is not an exception. There is  an increasing trend in the prevalence and mortality from major chronic diseases in the countries of the Americas. The rising prevalence of chronic diseased paired with lacking resources and acute disease focused programs, will result in a devasting impact on the well-being and the economic development of individual countries and the region as whole in the up-coming years. Methods: The Pan American Chronic Care Observatory (PACCO), an international collaboration involving the Pan American/ World Health Organization office in Washington DC, academic institutions and government offices across the Americas, was established during the period 2005-2016. Results: As part of PACCO, many tools were designed, disseminated and implemented across Latin America & the Caribbean such as the Passport for Healthy Lifestyle and the Health Technology Manual. Aiming to evaluate the impact of these activities a survey was conducted to describe existing initiatives focused on the integrated care for chronic conditions. Professionals from the United States, Brazil, Canada and Chile gathered information throughout the completion of a questionnaire and structured interviews of government officials and program managers. Overall 21 case studies were identified, 14 of which were from Latin America (Argentina, Brazil, Chile, Colombia, Costa Rica, Cuba, the Dominican Republic, Mexico and Puerto Rico). Examples of effective programs taking place in Canada (Provinces of Alberta and Ontario, the Program Inspired COPD, PHAC: Chronic Disease & Injury Framework) and the United States (the Kaiser Permanente Northern California Story, Improving Chronic Disease in a Small Primary Care Clinic in South Texas) were also included in the report. Most of the Latin America initiatives were national governmental programs except the six Brazilian cases that were local or state-based projects. Although most of the programs still lack evaluation and outcome data, the results of the survey indicated that change is coming, and many countries of Latin America are starting to focus in creating health programs to address the growing problem of chronic diseases. Survey results indicated a progressive application of the principles of the integrated management of chronic diseases such as planed care, care coordinators, self-management, group medical visit and risk stratification among others. Some programs have already shown positive results such as the national program AUGE in Chile that decreased out-of-pocket expenses and increased patient satisfaction; the national program of Argentina that demonstrated improvement in the control of hypertension and decreased stroke mortality;  and the Program at Rio Grande do Sul, Brazil that  increased coverage and improved control of hypertension and diabetes, as ell as decreased the number of Asthma hospital admission. Conclusions: Many programs were identified by this survey, many of them have already showed positive results in achieving better quality of care for chronic conditions. Lesson learned: Innovative approaches to chronic care needs to be identified and disseminated so experiences can be applied, adapted and improved in other context.