A demonstration project in seven municipalities will implement a chronic care model that promotes patient self-management to reduce complications and healthcare costs

Puerto Rico, 26 August 2014 (PAHO/WHO) — Puerto Rico's Department of Health will carry out a demonstration project to improve control or chronic diseases in seven municipalities in the island's northeast, with support from the Pan American Health Organization/World Health Organization (PAHO/WHO).

The project will implement the Chronic Care Model, developed by the MacColl Center for Health Care Innovation and adapted by PAHO/WHO, to improve care and promote self-management by patients with chronic diseases.

"We want to change from a medical focus on curing disease to a focus on keeping the population as healthy as possible to prevent illness and avoid complications," said Madeline Reyes García, deputy secretary for health promotion in the Puerto Rico Department of Health. The project also seeks to promote healthier lifestyles and positive behavior change in the population.


In Puerto Rico, half of all adults have at least one chronic disease, according to official data. Some 42.4% of the population is physically inactive, and 66.6% are overweight or obese. Heart disease, cancer, diabetes, asthma, arthritis and Alzheimer's disease are the top causes of death and disability.

"The good news is that these are mostly preventable diseases, which means it's essential to educate people on how to adopt healthy lifestyles, have better nutrition and more physical activity, and to stop smoking," said Reyes García.

The Chronic Care Model has been implemented in other countries of the Americas, including Argentina, Brazil, Chile, Colombia, Costa Rica, the Dominican Republic, Guatemala, Mexico, Nicaragua, and Paraguay. "It is a model that helps reduce hospitalizations due to diabetes, hypertension and other chronic conditions, but it also benefits health systems by increasing their effectiveness and reducing the costs of care," said PAHO/WHO Regional Advisor on Diabetes Alberto Barceló.

The model has six components: organization of care, community engagement, support for self-management, clinical information systems, design of service delivery systems, and support for clinical decisions.

Health authorities began a series of activities in March of this year to implement the model, including consultations with health providers to evaluate primary care services and patient questionnaires to measure their satisfaction with the services.

"Generally speaking, patients' satisfaction with services was very good, however, there are areas that we know need improving," said Jessica Irizarry Ramos, director of the Division of Chronic Disease Prevention and Control in the Department of Health. "We are going to work individually with each health center to respond to their specific needs."

On August 22 and 23, experts from the Department of Health, PAHO/WHO, Brazil and the Dominican Republic trained Puerto Rican health professionals in the Chronic Care Model. Participants prepared proposals based on the model that they will begin implementing in their workplaces in the coming months. If those experiences bring health improvements, health authorities plan to expand the model's implementation across the island.

One of the participants in the recent training sessions was Francisco Rivera Rodríguez, president of Puerto Rico's Integrated Health System of the East and director of the Isabelino Advanced Medicine Center. He said that 45—50% of the approximately 22,000 patients who come to his health center each year suffer from chronic diseases. He said the new model will further promote integrated work by multidisciplinary health teams, and "patients will learn to take control of their chronic conditions, which will help them have healthier, happier and more enjoyable lives."

Puerto Rico has been an Associate Member State of PAHO/WHO since 1992. The Organization has a special Coordination Office on the island, led by Dr. Raúl Castellanos.

Chronic diseases are one of the top priorities for PAHO/WHO's technical cooperation on the island. "Chronic diseases have replaced infectious diseases as the main cause of death throughout the Americas," said Castellanos. "We need to focus our efforts on addressing the reasons why the population becomes ill and why many people die prematurely." In this regard, Puerto Rico recently launched a new plan of action to prevent and control chronic diseases through 2020, with support from PAHO/WHO and the Alliance for Chronic Disease Control.