Browsing by Author "Seguel Araus, Romina Javiera"

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    An innovative multimorbidity patient-centered care model in Chile: implementation evaluation results
    (Springer Nature, 2025) Sapag Muñoz de la Peña, Jaime; Martínez Pérez, Mayra Alicia; Zamorano Pichard, Paula Francisca; Varela Yuraszeck, Teresita Inés; Muñoz, Paulina; Seguel Araus, Romina Javiera; Irazoqui Soto, Esteban; Tellez, Alvaro
    Background The impact of non-communicable diseases and multimorbidity challenges health systems worldwide. Latin America faces an urgent need to develop practical innovations in that regard. The Centro de Innovación en Salud ANCORA UC implemented a new Multimorbidity Patient-Centered Care Model (MPCM) pilot in Chile between 2017 and 2020. MPCM aimed to reorganize health services from a fragmented diagnosis-based perspective towards a new approach based on patient’s needs and offer intervention strategies according to their multimorbidity risk. This article aims to report the evaluation of the implementation process of MPCM in the Southeast Metropolitan Health District in Chile. Methods The study design corresponds to an implementation collaborative evaluation of MPCM innovation using qualitative methodology. Two main questions guided the research: (1) How has MPCM been implemented in its pilot phase? Moreover, (2) What are the main learnings from the MPCM pilot phase and their contribution to its scalability at the national level? In addition, the Consolidated Framework for Implementation Research and the Outcomes for Implementation Research were considered in the theoretical approach. Results Thirty-five (35) interviews were conducted with 69 professionals and key stakeholders involved in the implementation process of MPCM, including health practitioners, transition nurses who coordinate the intervention with the affiliated hospitals, managers, and the implementation team. Overall, the results were positive, suggesting that a complex innovation of this kind may be implemented successfully. Key lessons learned should be considered for scaling up MPCM to the national level. Some critical barriers to implementation were high staff turnover and the COVID-19 pandemic, while leadership and team commitment were relevant facilitators. Conclusions This study represents a new step in evaluating an innovative model for addressing multimorbidity in Chile. The scaling up phase requires careful consideration of all lessons learned, as well as a robust evaluation and monitoring plan. This research represents the first evaluative analysis of MPCM in the context of a complex innovation adapted to enhance public health policies using implementation evaluation approaches. Implementation Science is a fundamental approach to fostering quality improvement strategies for health care in Latin America.
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    Reducing household tuberculosis transmission. A pilot cluster-randomized controlled trial
    (2025) Ruiz-Tagle Seguel, Cinthya Grace; Seguel Araus, Romina Javiera; Villarroel del Pino, Luis A.; Bernales, Margarita; Vargas García, Salvador; Pizarro Ibañez, Alejandra Valentina; Peña, Carlos; Neira, Víctor; García Cañete, Patricia; Allel Henríquez, Kasim Ignacio; Nathavitharana, Ruvandhi R.; Balcells Marty, María Elvira
    Background: The duration of infectiousness following pulmonary tuberculosis treatment initiation remains uncertain. We aimed to assess whether a bundled intervention designed to decrease respiratory exposure was feasible and would reduce new tuberculosis infections in household contacts (HHCs). Methods: We conducted a pilot cluster-randomized controlled trial with a hybrid type 1 effectiveness-implementation design in Santiago, Chile. Random allocation was performed, and two healthcare districts were assigned to the intervention (n=180 HHCs) and one to standard of care (n=149 HHCs). Eligible participants were newly diagnosed pulmonary tuberculosis patients and their HHCs. The intervention included education, mask use, household ventilation, and nightly separation of tuberculosis patients, for two weeks. Intervention adherence was evaluated weekly. Effectiveness was assessed at the individual level with QuantiFERON®-TB Gold Plus (QFT) test conversions in HHCs at 12-week follow-up. Results: Between October 2021 and December 2023, 384 HHCs and 157 tuberculosis patients were enrolled. Overall, 56.3% of contacts were women, with mean age of 34.6 years and a baseline QFT positivity of 32.3%. A total of 216 contacts had negative QFT result at baseline, with 179 (82.9%) completing follow-up. QFT conversions occurred in 11 (12.8%) and 10 (10.8%) HHCs from the intervention and control arms, respectively (incidence risk ratio 1.10, 95% CI 0.71-1.71, p=0.849). Good adherence to the respiratory bundle was reported by 53% of participants on day 7 and 54% on day 14.