1. Selfcare Projects at PUC E.U. Ilta Lange M.S.N Profesor Titular y Directora Centro Colaborador OMS Escuela de Enfermería

2. Health Reform in Chile Improve health of the population and reduce the existing inequities (Superintendencia de Salud www.superintendenciadesalud.clwww.superintendenciadesalud.cl )

3. Health Reform in Chile Objectives  Improve efficacy of health care interventions  Increase solidarity in the financial system  Improve equity in access and quality of health services  Improve efficiency of the health care system, in a sustainable manner  Respond to the expectations of the population: more participation and social control.

4. Health Reform in Chile Objectives  Improve efficacy of health care interventions  Increase solidarity in the financial system  Improve equity in access and quality of health services  Improve efficiency of the health care system, in a sustainable manner  Respond to the expectations of the population: more participation and social control.

5. 4 Lines of Action: 1) Prioritizing chronic disease in public health agenda and policy 2) Establishing surveillance 3) Improving health systems to better respond to needs 4) Working on health promotion and disease prevention PAHO / WHO REGIONAL STRATEGY Sept 2006 Regional Strategy on Prevention and Control of Chronic Disease Regional Strategy on Prevention and Control of Chronic Disease.

6. Selfcare Projects at PUC 1983-2008 E.U. Ilta Lange M.S.N Profesor Titular y Directora Centro Colaborador OMS Escuela de Enfermería

7. 1983-1985 W.K.Kellogg Foundation Inclusion of selfcare education as a permanent component of health care at ambulatory clinic of Pontificia Universidad Católica de Chile

8. 1985-1989 W.K.Kellogg Foundation Inclusion of the selfcare concept as a permanent component of health care at the Catholic University health care network. Incorporation of the selfcare nursing concept in the undergraduate curriculum at the School of Nursing.

9. Dissemination of this innovation in Chile and other Latin American countries. School of Nursing is recognized at Pan American Health Organization for its expertise in providing selfcare support. 1989 Creation of the Office for health promotion and Selfcare W.K.Kellogg Foundation

10. 1989-1991 Project “Nursing Leadership for Primary Health Care” W.K.Kellogg Implementation of a distance learning program

11. Evaluation of the selfcare model 1995- 1997 “Effects of a comprehensive health care model, based on selfcare, for a maternal child population. (Proyecto FONDECYT)

12. Health decision support for women in underserved communities. 1999- 2004 “ DECIDE” (Escuela de EnfermeríaUC/ Universidad de Ottawa/ La Pintana/ Canadian International Development Agency)

13. Technical Support from the University of Ottawa, University of Michigan and Veterans Administration Financial Support: Canadian Institutes for Health Research/ FONDEF/ Ministry of Health 2004-2008 “ Development of a nurse managed telephone mediated selfcare support model for patients with chronic diseases.

14. Remote Health Care Telephone outreach has been found to be an effective and cost-efficient extension of clinic-based diabetes services Telephone-based care management allows for frequent patient contacts at a low cost and improves chronic illness self-care and health outcomes

15. Remote Health Care Phone use is becoming common throughout Latin America In Chile, it is an unused strategy to support self- management of patients with diabetes or other chronic diseases

16. Remote Health Care Phone use is becoming common throughout Latin America In Chile, it is an unused strategy to support self- management of patients with diabetes or other chronic diseases

17. Institutional Barriers Health care model organized for patients with acute health problems Human resources: insufficient, turnover, sick leaves Caseload: 1 patient every 10 minutes No networking between primary, secondary and tertiary level of care Ineffective communication between professionals and patients

18. Institutional Barriers Health care model organized for patients with acute health problems Human resources: insufficient, turnover, sick leaves Caseload: 1 patient every 10 minutes No networking between primary, secondary and tertiary level of care Ineffective communication between professionals and patients

19. Patient Related Barriers Difficulties in accessing the health care systems Health literacy deficit Financial problems Inadequate family support

20. Dissemination

21. Principal Investigator Ilta Lange, R.N., MSc.* Pontificia Universidad Católica de Chile email: ilange@uc.clilange@uc.cl Co-Investigators Solange Campos, NM,MPs*, Lilian Ferrer R.N., PhD*, John Piette,PhD**, Mila Urrutia,RN, MCH*, Jaime Sapag MD, MPH *, Claudia BustamanteNM*, Claudia Alcayaga NM *, Francisca Zúñiga,Nutr. MPH,***, Sergio Araya, MD***, Alvaro Tellez,MD*, Luis Villaroel PhD*, Dawn Stacey,R.N.,PhD**** * Pontificia Universidad Católica de Chile ** University of Michigan *** Department of Health, Commune of Puente Alto, Santiago, Chile **** University of Ottawa Implementation of a Telephone Support Service for Patients with Type 2 Diabetes, Integrated with Public Primary Health Care