Recommendations for strengthening primary healthcare delivery models for chronic disease management in Mendoza: a RAND/UCLA modified Delphi panel.

Abstract

Background: Primary healthcare (PHC) should be the cornerstone of equitable, efficient and high-quality healthcare in low- and middle-income countries. However, numerous challenges undermine its effectiveness in these settings.

Objective: To identify recommendations to improve PHC by integrating user preferences and provider capacity to deliver patient-centred and competent care in the Mendoza Province, Argentina.

Design: Modified RAND Corporation/University of California, Los Angeles (RAND/UCLA) Delphi method.

Setting: Health system of the Province of Mendoza, Argentina.

Participants: 32 public health experts from Mendoza.

Interventions: Proposals were developed from secondary data, the People's Voice Survey, an electronic cohort of people with diabetes, qualitative studies of users' and professionals' experiences and reviews of interventions in primary care.

Primary outcome: Experts had to evaluate proposals according to five criteria selected from the evidence to decision framework (impact, resource requirements, acceptability, feasibility and measurability).

Results: The 19 final recommendations emphasise policy continuity, evidence-based policy-making and standardisation of healthcare processes. Key areas include optimising healthcare processes, managing appointments for non-communicable diseases and ensuring competency-based training in PHC. Implementing performance-based incentives and improving financial sustainability were also highlighted. Other recommendations focus on the Digital Transformation Act, user participation in healthcare design and skills development for active engagement. Collaborative definitions of quality care, incident reporting systems and performance metrics are critical to improving healthcare quality.

Conclusion: This process provided decision-makers with contextualised information for health policy development. These interventions represent a step towards improving PHC, particularly chronic disease management, and provide a foundation for future regional research and health policy.