Publications by authors named "Alejandro Escobar Mesa"

3 Publications

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Using collaborative learning to improve diabetes care and outcomes: the VIDA project.

Prim Care Diabetes 2010 Oct 15;4(3):145-53. Epub 2010 May 15.

Pan American Health Organization, Washington, DC 20037-2895, USA.

Unlabelled: The prevalence of diabetes in Mexico among those 20-64 years of age has increased from 7.2% in 1993 to 10.7% in 2000. National population-based surveys in Mexico demonstrated that 50% of the total population with diabetes had blood glucose levels of 200mg/dl or higher. Thus, diabetes care has become one of the most important public health challenges in this country. The aim of the study was to improve the quality of diabetes care in primary health care centers using the chronic care model and the breakthrough series (BTS) collaborative methodology.

Methods: Ten public health centers in the cities of Xalapa and Veracruz were randomly selected to participate in the project. Five of the health centers were randomly assigned to receive the intervention (intervention group) and the other five followed usual care (usual care group). The intervention was evaluated by A1c test before and after the intervention in both groups of patients. Patients were followed for 18 months from November 2002 to May 2004. Results were adjusted for the clustering of patients within practices and baseline measure.

Results: The proportion of people with good glycemic control (A1c<7%) among those in the intervention group increased from 28% before the intervention to 39% after the intervention. The proportion of patients achieving three or more quality improvement goals increased from 16.6% to 69.7% (p<0.001) among the intervention group while the usual care group experienced a non-significant decrease from 12.4% to 5.9% (p=0.118). The focus on the primary care team and the participation of people with diabetes were strategic elements incorporated into the methodology, expected to ensure sustainability of continued improvement of health outcomes.

Conclusions: The intervention introduced modifications to solve problems identified by health teams in their practice and improved process and outcome measures of quality diabetes care. Most of the actions were directed at four components of the chronic care model: self-management support, decision support, delivery system design, and clinical information systems.
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October 2010

[Epidemiology of Chagas disease in the state of Veracruz].

Salud Publica Mex 2005 May-Jun;47(3):201-8

Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, México, DF, México.

Objective: To assess the seroprevalence, household risk factors, and entomological indicators, in order to frame control measures in 11 Sanitary Jurisdictions of the state.

Material And Methods: This study included 281 towns, 2 526 households, and 9782 individuals. Data were collected using a questionnaire. Blood was obtained in filter paper and a search for triatomines was conducted inside of and around dwellings. Prevalence rates were used to quantify exposure to risk factors and seropositivity. Odds ratios with 95% confidence intervals and Mantel-Haenszel chi-squared tests were obtained. Multivariate analysis was performed with unconditional logistic regression,variables included in the model were those that had a p-value up to 0.20 in the bivariate analysis. The etiologic fraction in the exposed was also obtained.

Results: The prevalence of Chagas disease was between 0 and 2.8%. Jurisdictions at a higher risk wereTuxpan, Panuco and Cordoba; Orizaba showed no risk. The main household risk factors were palma/zacate (palm-tree, grass leaves) roof and walls, dirt floor, the presence of the vector, and ventilation.

Conclusions: Epidemiological surveillance should emphasize health education, housing improvement, and use of insecticides.
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October 2005