John N. Lavis, MD, PhD Professor and Canada Research Chair in Knowledge Transfer and Exchange McMaster University Program in Policy Decision-Making McMaster University 27 October 2009 Policy Briefs Workshop: Framing Options - Roundtable EVIPNet Policy Briefs Workshop Santiago, Chile

2 Framing the options to improve diabetes management in Buenos Aires province Introduce a training program to improve diabetes management at the primary healthcare level (and improve clinical services in health centres and laboratories) Strengthen the system of referrals among the three levels involved in diabetes management o Provide management training to those in leadership positions in each of the levels o Review and improve the entire process of referrals, including the allocation of staff to particular shifts, appointment scheduling, and how staff turn-over is handled Strengthen the regional program and support integration with related national programs Q1: What Are the Options? (ARG)

3 Framing options to improve adherence to norms and guidelines for the management of diabetes Change undergraduate medical curricula to provide the skills needed to find, assess and use guidelines in primary healthcare Promote and support the use of diabetes guidelines by physicians starting their primary healthcare practice (and those already working in primary healthcare practices) Introduce a financial incentive for adherence to high- priority (diabetes) guidelines Q1: What Are the Options? (MEX)

4 Framing options to improve the quality of care provided to diabetics, esp. at the secondary level Raise awareness among and train staff to support their adherence to diabetes norms and standards Improve the third-party assessments systems to give greater attention to adherence to norms and standards, and support the use of existing financial incentives to make improvements in areas prioritized through the third-party assessments (and improve in-house assessments as well) Support self-management by providing training to patients and their families and by improving community resources to support them Q1: What Are the Options? (COR)

5 Framing options to improve secondary prevention among diabetes, particularly among excluded groups Communication campaigns targeted both at patients (respecting ethno-cultural and language differences) and at providers, with leadership from communication units in each of the 17 regions Provide training at the local, regional and national levels to support self-management by patients and their families, the use of guidelines by healthcare providers (including health promoters), and the management of diabetes programs and services in line with nat’l norms Introduce financial incentives to promote adherence to diabetes guidelines Q1: What Are the Options? (PAR)

6 Framing options to reduce risk factors for and complications from diabetes Do nothing (status quo) Support community health workers in improving their reach and impact (in providing programs and services that have been shown to be effective) Increase use of mobile trailers to provide effective programs and services to hard-to-reach diabetics Q1: What Are the Options? (FEP)

7 Framing options to reduce neonatal mortality from gestational diabetes Increase the participation of communities in supporting the widespread use of more effective programs and services for diagnosing and managing gestational diabetes Supporting changes in the clinical management of gestational diabetes Enhance the monitoring and evaluation of gestational diabetes Q1: What Are the Options? (BRA)

8 Options can include one or many option elements Status quo is always an option (whether it’s stated as an option or is the comparator against which other options are compared) Other Observations