1. John N. Lavis, MD, PhD Professor and Canada Research Chair in Knowledge Transfer and Exchange McMaster University Program in Policy Decision-Making McMaster University 28 October 2009 Policy Briefs Workshop: Bringing About Change - Roundtable EVIPNet Policy Briefs Workshop Santiago, Chile

2. 2 Option Improve adherence to diabetes guidelines in primary healthcare Barriers Time constraints faced by medical staff Turn-over among medical staff Resistance to training by people from other levels Perceived implications for their clinical autonomy Strategies (note that the first two strategies don’t address barriers) Education(al system) (note that this needs further elaboration) Reminders (but this may be difficult in rural areas) (Organizational interventions targeted at itinerant services) Q: What Are the Barriers & Strategies (MEX)

3. 3 Option Strengthen capacities/competencies for diabetes management Barriers Consumers - Doctor/patient relations, perceptions of loss to care Health workers (2) – Concerns about loss of power Health workers (1) – Concerns about more work at same pay Organizational – Lack of service institutionalization, fragmentation Systems – Fragmentation Strategies Patients – Self-management workshops/communication campaigns Providers – Continuing medical education workshops Organizations – Policy briefs and dialogues System – Financial incentives for providers at first level Q: What Are the Barriers & Strategies (ARG)

4. 4 Option Support self-management Barriers Health workers – Lack of engagement in continuing education Organizations - ? Patients – Access challenges, overloaded teams Strategies Health workers – Educational strategies, computers Q: What Are the Barriers & Strategies (COR)

5. 5 Option Communication strategies to support diabetes management Barriers Systems – Inadequate communication support change management, excessive verticality in implementation, resource allocation challenges, active opposition to change among some groups Organizations – Lack of integration across programs, resource constraints, poor motivation, resistance among physicians Consumers – Cultural, perceptions about welcome, literacy, access Strategies Stakeholder-engagement processes Q: What Are the Barriers & Strategies (PAR)

6. 6 Option Improved screening for gestational diabetes Barriers Patients - Resistance Health workers – Lack of adherence to guidelines and capacity to implement them Organizations – Resource constraints in primary healthcare Systems – Lack of dedicated budget line for this Strategies Patients – Community discussions Health workers – Awareness-raising / Support for practice change Organizations/system – Public financing of screening Q: What Are the Barriers & Strategies (BRA)

7. 7 Option Improved use of community health workers to support diabetes prevention Barriers Patients – Lack of acceptance of community health workers Health workers – Poor training and pay Organizations/systems – Lack of communication and coordination Strategies Evaluation of effects, costs, and cost-effectiveness of community health workers program Increase types of funding and stabilize the total funding Q: What Are the Barriers & Strategies (FEP)

8. 8 Implementation strategies shouldn’t dwarf the options that they are supporting Barriers need to be rank-ordered in importance and strategies targeted at most significant barriers Other Observations