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This article describes the main models for embedding research and the successful experiences and challenges faced in joint work by researchers and decisionmakers who participated in the Embedding Research for the Sustainable Development Goals (ER-SDG) initiative, and the experience of the Technical Support Center. In June 2018, funding was granted to 13 pre-selected research projects from 11 middle- and low-income countries in Latin America and the Caribbean (Argentina, Bolivia, Brazil, Colombia, Dominican Republic, Ecuador, Guatemala, Guyana, Haiti, Paraguay, and Peru). The projects focused on the system-, policy-, or programlevel changes required to improve health and build on the joint work of researchers and decisionmakers, with a view to bringing together evidence production and decision-making in health systems and services. The Technical Support Center supported and guided the production of quality results useful for decision-making. This experience confirmed the value of initiatives such as ER-SDG in consolidating bridges between research on the implementation of health policies, programs, and systems, and the officials responsible for operating health-related programs, services, and interventions. It highlighted the importance of both respecting and taking advantage of each context--and the specific arrangements and patterns in the relationships between researchers and decisionmakers--through incentives for embedded research. [ABSTRACT FROM AUTHOR]

This article describes the main models for embedding research and the successful experiences and challenges faced in joint work by researchers and decisionmakers who participated in the Embedding Research for the Sustainable Development Goals (ER-SDG) initiative, and the experience of the Technical Support Center. In June 2018, funding was granted to 13 pre-selected research projects from 11 middle- and low-income countries in Latin America and the Caribbean (Argentina, Bolivia, Brazil, Colombia, Dominican Republic, Ecuador, Guatemala, Guyana, Haiti, Paraguay, and Peru). The projects focused on the system-, policy-, or program-level changes required to improve health and build on the joint work of researchers and decisionmakers, with a view to bringing together evidence production and decision-making in health systems and services. The Technical Support Center supported and guided the production of quality results useful for decision-making. This experience confirmed the value of initiatives such as ER-SDG in consolidating bridges between research on the implementation of health policies, programs, and systems, and the officials responsible for operating health-related programs, services, and interventions. It highlighted the importance of both respecting and taking advantage of each context--and the specific arrangements and patterns in the relationships between researchers and decisionmakers--through incentives for embedded research. [ABSTRACT FROM AUTHOR]

Competing Interests: Competing interests: None declared.

Objective. To assess the performance of primary health care (PHC) in Brazil and its association with the More Doctors Program (Programa Mais Médicos, PMM). Method. This nationwide cross-sectional study used the Primary Care Assessment Tool validated for Brazilian Portuguese (PCATool-Brasil) to determine the achievement of PHC according to user experience associated with three physician categories: Brazilian physicians participating in the PMM, Cuban physicians participating in the PMM, and Brazilian physicians not linked to the PMM. The following PHC scores were calculated: overall PCA score, accessibility (first contact), and longitudinality. The association between PHC scores, physician category, and other user and physician characteristics was investigated using multilevel analysis. Results. The overall PCA score for Brazil was 6.78, and the longitudinality score was 7.43. There was no difference in these scores among the three physician categories. The overall accessibility score was 4.24. A small but significant difference (P < 0.001) in accessibility score was detected among physician categories: 4.43 for Cuban physicians participating in the PMM (CI: 4.32-4.54), 4.08 for Brazilian physicians participating in the PMM(CI: 3.98-4.18), and 4.20 for Brazilian physicians not linked to the PMM (CI: 4.09-4.32). Age, socioeconomic level, presence of chronic diseases, and home visits by physicians positively influenced the overall PCA score on multilevel analysis. Conclusions. The type of physician did not influence the primary care orientation (overall score) of the healthcare system in Brazil. PMM was associated with higher accessibility sores in more socioeconomically vulnerable areas. Multilevel analysis showed that PCH may be strengthened by the reinforcement of essential physician roles (such as home visits) and by improving access for socioeconomically vulnerable, younger populations or those without chronic diseases. [ABSTRACT FROM AUTHOR]

Objective. Describe the current status of the implementation of the Model of Comprehensive Care in Family and Community Health (MAIS, by its acronym in Spanish) in primary care in Chile. Methods. Cross-sectional study that evaluated the implementation of MAIS in a total of 1 263 primary care facilities. Through correlations, the relationship between internal self-evaluation and external evaluation of health services for each center was studied. The factors of facilities, communes and regions associated with the level of implementation of the MAIS were evaluated with multilevel analyses. Results. The correlation between internal self-evaluation and the external evaluation of the total implementation of the MAIS was very high (0.819, p <0.001). The technology axis presented the highest implementation (83.0% compliance), and family focus the lowest (37.8% compliance). The facilities with the highest implementation were family health centers, the urban communes, those with the highest number of enrollees and those with the lowest poverty index. A statistically significant association was not identified between the implementation of the MAIS and the total community expenses (p = 0.122) nor specific health expenditures (p = 0.244). Conclusions. Most of the primary care health facilities have evaluated the level of implementation of the MAIS. The accompanying strategies for its implementation are priorities for primary care facilities located in rural areas and with a low number of registered users. Improving the family focus and the quality of care --key aspects of health care-- are still a challenge. [ABSTRACT FROM AUTHOR]

Objective. To describe the availability of local mental health (MH) services in small MH catchment areas in Central Chile, using a bottom-up approach. Methods. MH services of 19 small MH catchment areas in five health districts of Central Chile that provide health care to more than 4 million inhabitants were assessed using DESDELTC (Description and Evaluation of Services and Directories in Europe for Long-Term Care), a tool for standardized description and classification of LTC health services, in a study conducted in 2012 ("DESDE-Chile") designed to complement other studies conducted in 2004 and 2012 at the national and regional level using the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS). Key informants from national, regional, and local health authorities were contacted to compile a comprehensive list of MH services or facilities (health, social services, education, employment, and housing). The analysis of local care provision covered three criteria--service availability, placement capacity, and workforce capacity. Results. The study detected disparities in all three criteria (availability and placement and workforce capacity) across the five health districts, between urban and rural areas, and between neighboring urban areas. Analysis of service availability revealed differences in the weight of residential services versus day and outpatient care. The Talcahuano area could be considered a benchmark of MH care in Central Chile, based on its service provision patterns, and the criteria of the community care model. The list of MH services identified in this study differed from the one generated in the 2012 WHO-AIMS study. Conclusions. This survey of local MH service provision in small catchment areas using the DESDE-LTC tool provided MH service provision data that complemented information collected in other studies conducted at the national/regional level using the WHO-AIMS tool. The bottom-up approach applied in this study would also be useful for the assessment of equity and accessibility and local planning. [ABSTRACT FROM AUTHOR]

Objective. To measure the prevalence of various care services offered to the elderly with diabetes mellitus in Brazil, and to assess the social inequalities in these services. Methods. This cross-sectional, population-based study was carried out in 2013. The care services offered were evaluated in terms of the following eight indicators: recommendations to lower carbohydrates, to measure blood glucose, and to examine the feet; requests made for blood tests, for glycated hemoglobin tests, and for glycemic curve tests; and whether service users had had their eyes or feet examined in the previous year. We used the slope index of inequality and the concentration index to assess the inequalities among wealth quintiles. Results. A total of 1 685 elderly persons with diabetes were evaluated. Overall, 41.7% of them had had their eyes examined in the preceding year, 35.4% had had their feet examined in the preceding year, and 10.9% had been offered all eight of the care services. The largest absolute differences (in percentage points) between the first (poorest) and fifth (richest) wealth quintiles in terms of the care services that were offered to the users were for: a recommendation to measure blood glucose (25.8), a glycated hemoglobin test request (27.4), a glycemic curve test request (31.9), having the eyes examined in the preceding year (29.3), and having the feet examined in the preceding year (27.0). Conclusion. There were notable inequalities in the prevalences of the care services. In the future, measurement of blood glucose and examination of the feet should be emphasized, especially for elderly persons in a lower socioeconomic level. [ABSTRACT FROM AUTHOR]

This report contributes towards the monitoring and evaluation of the Pan American Health Organization/ World Health Organization (PAHO/WHO) Policy on Research for Health (CD49/10), specifically, how it has been used by Member States and how it has influenced their policies, strategies, research, and relevant stakeholders. This cross-sectional study examined the frequency, method of utilization, region of interest or "scope," and rationale behind citing the Policy in PAHO/WHO documents, databases, government websites, and internal documents. The extent of utilization was measured through an ordinal scale; the country or region of interest was systematically extracted. Of the 993 documents that were identified through the search strategy, 95 met the inclusion criteria. There was a significant relationship between type of document and scope (χ²2 = 69.5; P < 0.001), with web pages and scientific articles covering the Americas more frequently mentioning the Policy. The Policy was most often used at the country level in government documents and at the regional level in webpages and journal articles. Although the Policy has been utilized by several countries, many countries have yet to integrate it with their national health research initiatives. Additional research should focus on understanding why Policy utilization differs among countries. To promote better cohesion across sectors and levels of governance, researchers and policymakers should seize opportunities to integrate the Policy with the research process, research governance, and policy development. The protocol developed for this study can be applied to similar analyses of other PAHO/WHO policies to gain a greater understanding of their influence. [ABSTRACT FROM AUTHOR]

Objectives. Three highly effective vaccines are available to prevent human papillomavirus (HPV) infection, and they have been introduced in many countries around the world. This article describes advances and challenges in introducing HPV vaccines in the Expanded Program of Immunization (EPI) of countries in Latin America and the Caribbean (LAC). Methods. We reviewed national and regional sources of information to identify LAC countries with and without universal HPV vaccination, along with the year of introduction, type of HPV vaccine, vaccination scheme, age groups targeted, and coverage level reached. Incidence rates of cervical cancer were compared across countries with and without an HPV vaccination program, in order to identify inequities in access to HPV vaccines. Results. So far, 10 LAC countries have supplied data on their vaccination policies and vaccination coverage rates to the Pan America Health Organization. The majority of those 10 started their vaccination programs using quadrivalent vaccine. Only Chile, Ecuador, and Mexico started their programs using a two-dose scheme. However, by the end of 2016, most of the other countries had switched from a three-dose to a two-dose scheme. Different age groups are targeted in the various programs. Some countries vaccinate one-year birth cohorts, while others vaccinate multiple-year birth cohorts. By the end of 2014, coverage with at least two doses ranged from a low of 2% to a high of 86%. With the exception of Venezuela, the LAC countries with the largest populations introduced universal HPV vaccination between 2010 and 2014. Despite the progress that has occurred in some LAC countries, there are still 10 LAC nations with cervical cancer rates above the LAC average (21.2 cases per 100 000) that have not introduced an HPV vaccine in their EPI. Conclusions. With several key adjustments, HPV vaccination programs across Latin America and the Caribbean could be substantially strengthened. Ongoing monitoring of HPV infection outcomes is needed in order to assess the impact of different vaccination policies. [ABSTRACT FROM AUTHOR]

Objective. Search for conceptual frameworks or models that incorporate aspects of health equity into implementation research and prepare a systematic synthesis of them. Methods. A systematic search was done of MEDLINE-PubMed, Embase, and LILACS (1965-2016), and Scopus (1998-2016) databases, employing, in addition, a snowball strategy and gray literature search. Article type was assessed, along with elements that were included on implementation research, the science of implementation, and health equity. Results. A total of 701 articles were found, of which 100 were included for review of relevance. Of these, 19 articles related to conceptual frameworks: 12 were general, five were on ethnic or racial disparities, and two related to child health. The most frequent categories were financing, infrastructure, advocacy, quality, internal barriers, and coverage. The least frequent were other sectors, outpatient needs, health status, and equity impact assessment. Conclusions. In order to reduce health gaps and with them health inequities, it becomes necessary to have a consolidated implementation research framework that includes aspects of health equity. This framework would facilitate improving implementation processes for interventions, services, and health programs. [ABSTRACT FROM AUTHOR]

This report summarizes the presentations, discussions and the recommendations coming from the Oswaldo Cruz Institute/FIOCRUZ International Workshop for Leptospirosis Research Based on Country Needs and the 5th Global Leptospirosis Environmental Action Network meeting, which was held in the city of Rio de Janeiro, Brazil, 10-12 November 2015. The event focused on health policy and worked to develop a road map as a consensus document to help guide decision-making by policy makers, funding bodies, and health care professionals. The direction that leptospirosis research should take in the coming years was emphasized, taking into account the needs of countries of Latin America, as well as experiences from other world regions, as provided by international experts. The operational concepts of "One Health" and translational research underlaid the discussions and the resulting recommendations. Despite the wide geographic distribution of leptospirosis and its impact in terms of incidence, morbidity, and mortality, leptospirosis is not yet considered a "tool-ready" disease for global initiatives. Surveillance programs need new tools and strategies for early detection, prevention, and follow-up. The major recommendations developed at the Rio meeting cover both health policy and research. The health policy recommendations should be taken into account by decisionmakers, government officials, and the Pan American Health Organization. The priorities for research, technological development, and innovation should be considered by research institutions, universities, and stakeholders. [ABSTRACT FROM AUTHOR]

Low- and middle-income countries (LMIC) lack the research infrastructure and capacity to conduct rigorous substance abuse and mental health effectiveness clinical trials to guide clinical practice. A partnership between the Florida Node Alliance of the United States National Drug Abuse Treatment Clinical Trials Network and the National Institute of Psychiatry in Mexico was established in 2011 to improve substance abuse practice in Mexico. The purpose of this partnership was to develop a Mexican national clinical trials network of substance abuse researchers and providers capable of implementing effectiveness randomized clinical trials in community-based settings. A technology transfer model was implemented and ran from 2011-2013. The Florida Node Alliance shared the "know how" for the development of the research infrastructure to implement randomized clinical trials in community programs through core and specific training modules, role-specific coaching, pairings, modeling, monitoring, and feedback. The technology transfer process was bi-directional in nature in that it was informed by feedback on feasibility and cultural appropriateness for the context in which practices were implemented. The Institute, in turn, led the effort to create the national network of researchers and practitioners in Mexico and the implementation of the first trial. A collaborative model of technology transfer was useful in creating a Mexican researcher-provider network that is capable of changing national practice in substance abuse research and treatment. Key considerations for transnational technology transfer are presented. [ABSTRACT FROM AUTHOR]

Objective. To provide an overview of comprehensive primary health care (CPHC) development and implementation in Suriname in peer-reviewed literature. Methods. Building on work funded by the Teasdale-Corti Global Health Research Partnership Program/People's Health Movement, the authors searched MEDLINE, the Cochrane Library, and POPLINE for articles focused on CPHC within the Surinamese context. Two authors independently reviewed abstracts and then jointly reviewed the selected abstracts. The final selection was completed using a data extraction form. Results. The initial search resulted in 1 556 abstracts. The initial review identified 58 articles. Only three of the 58 articles met the inclusion criteria for the final review. The three selected articles provided partial overviews of CPHC in Suriname and examples of its implementation, with a focus on the service delivery network in the interior of the country, which was designed to improve rural access to basic health care services by training community members as service providers. They also included examples of how preparations for health reform in Suriname in the late 1990s and early 2000s, influenced by global neoliberal reforms, led to expectations that disparities in health status, design of health system components, and service provision related to differences in power and historical context (e.g., the influence of medical professionals, political parties / ethnic groups, and wealthier populations concentrated in urban areas) would be addressed. Conclusions. Given the focus on primary health care in the Americas and the notable developments that have occurred in Surinamese health policy and health care, particularly in health care reform, the paucity of published research on CPHC in Suriname was an unexpected finding that may be partly due to prioritizing research on disease control rather than health policy and systems research. The limited amount of scientific literature on this topic 1) prevents clear understanding of CPHC development and implementation in Suriname and 2) underscores the need to strengthen the national health research system to better inform policies for moving the country toward universal health access and coverage to improve the health of all of its citizens. [ABSTRACT FROM AUTHOR]

Objective. To systematically review literature on priorities in nursing research on health systems and services in the Region of the Americas as a step toward developing a nursing research agenda that will advance the Regional Strategy for Universal Access to Health and Universal Health Coverage. Method. This was a systematic review of the literature available from the following databases: Web of Science, PubMed, LILACS, and Google. Documents considered were published in 2008-2014; in English, Spanish, or Portuguese; and addressed the topic in the Region of the Americas. The documents selected had their priority-setting process evaluated according to the “nine common themes for good practice in health research priorities.” A content analysis collected all study questions and topics, and sorted them by category and subcategory. Results. Of 185 full-text articles/documents that were assessed for eligibility, 23 were selected: 12 were from peer-reviewed journals; 6 from nursing publications; 4 from Ministries of Health; and 1 from an international organization. Journal publications had stronger methodological rigor; the majority did not present a clear implementation or evaluation plan. After compiling the 444 documents' study questions and topics, the content analysis resulted in a document with 5 categories and 16 subcategories regarding nursing research priorities on health systems and services. Conclusions. Research priority-setting is a highly important process for health services improvement and resources optimization, but implementation and evaluation plans are rarely included. The resulting document will serve as basis for the development of a new nursing research agenda focused on health systems and services, and shaped to advance universal health coverage and universal access to health. [ABSTRACT FROM AUTHOR]

Objective. Understand and analyze procedures used to create national integrated research agendas from 2007 to 2011 in Argentina, Guatemala, Mexico, Panama, and Paraguay. Methods. Descriptive, cross-sectional study using an online survey of agenda preparation processes; specifically, development, integration, implementation, and use and dissemination of the agenda. Results. The 45 respondents reported following specific methodologies for agenda construction and had a good opinion of organizational aspects with regard to prior information provided and balance among disciplines and stakeholders. Some 60% considered the coordinators impartial, although 25% mentioned biases favoring some subject; 42% received technical support from consultants, reading matter, and methodological guidelines; 40% engaged in subject-matter priority-setting; and 55% confirmed dissemination and communication of the agenda. However, only 22% reported inclusion of agenda topics in national calls for research proposals. Conclusions. In the countries studied, development of the health research agenda was characterized by prior planning and appropriate organization to achieve consensus-based outcomes. Nevertheless, the agendas were not used in national calls for research proposals, reflecting lack of coordination in national health research systems and lack of connection between funders and researchers. It is recommended that stakeholders strengthen integration and advocacy efforts to modify processes and structures of agenda-based calls for research proposals. [ABSTRACT FROM AUTHOR]

Translating Research at SingHealth: Cancer. Translating Research at SingHealth: Cardiometabollic Diseases. Translating Research at SingHealth: Eye Diseases. Translating Research at SingHealth: Health Services Research. Translating Research at SingHealth: Infectious Diseases. Translating Research at SingHealth: Neurosciences (Stroke). [ABSTRACT FROM AUTHOR]

Objective. To learn the perceptions of decision-makers concerning the implementation stage of a hospital self-management policy in two highly complex hospitals in southern Chile. Methods. A descriptive, exploratory, qualitative study based on semi?structured in-depth interviews of decision-makers at the Regional Hospital of Valdivia and the Hospital San José de Osorno from August 2010 to December 2011. A convenience sample of 26 decision-makers was selected. The 26 interviews were recorded and transcribed verbatim. The information was analyzed using inductive content analysis. Results. The interviewees consider the concept of self-management to be determined by autonomy in decision-making about resource allocation and the financing of health service delivery in the hospitals. They also stated that human resources and financing policies should be included to improve the implementation stage. They related weaknesses with the lack of organizational capabilities and managerial skills in the health teams implementing the changes. Conclusions. Conceptually, the hospital self-management policy is based on financial autonomy, and implementation is affected by persistent capacity gaps in policy design. [ABSTRACT FROM AUTHOR]

Objective. To analyze the cost of a self-owned network maintained by a Brazilian health insurance provider as compared to the price charged by accredited service providers, so as to identify whether or not the self-owned network is economically advantageous. Methods. For this exploratory study, the company's management reports were reviewed. The cost associated with the self-owned network was calculated based on medical and dental office visits and diagnostic/laboratory tests performed at one of the company's most representative facilities. The costs associated with third parties were derived from price tables used by the accredited network for the same services analyzed in the self-owned network. The full-cost method was used for cost quantification. Costs are presented as absolute values (in R$) and percent comparisons between self-owned network costs versus accredited network costs. Results. Overall, the self-owned network was advantageous for medical and dental consultations as well as diagnostic and laboratory tests. Pediatric and labor medicine consultations and x-rays were less costly in the accredited network. Conclusions. The choice of verticalization has economic advantages for the health care insurance operator in comparison with services provided by third parties. [ABSTRACT FROM AUTHOR]

Objectives. To rate the efficiency of all the outpatient clinics in Matanzas, Cuba; identify the best-performing clinics; and find opportunities for improvement at the others. Methods. A descriptive study of the 40 outpatient clinics in the province of Matanza was carried out during the first trimester of 2006. Clinics were grouped according to the complexity of services they offer and the socioeconomic level of the municipality in which they are located. Five output and six input variables were analyzed. Calculations were performed using data envelopment analysis, including optimization of results and constant and variable returns-to-scale. Results. In general, the clinics studied had high efficiency rates, with a mean of 0.95 ± 0.11. Eleven (27.5%) clinics studied were rated inefficient (0.77 ± 0.12). The following Three key areas for improvement were identified: increasing tuberculosis detection rates in the community, reducing rates of preventable infant mortality, and expanding immunization coverage. Among the 11 clinics rated as inefficient, there were resource gaps in at least one indicator. Conclusions. By recognizing successful clinics, best practices were identified that could be used to improve the weaker clinics. The resource distribution process should be reviewed to ensure that additional, unneeded resources are not used to improve efficiency. [ABSTRACT FROM AUTHOR]

Objective. To analyze the relationship between the occurrence of deaths that are avoidable with adequate health care and the reorganization of the Brazilian health care system between 1983 and 2002. Method. This ecological study analyzed avoidable mortality in 117 municipalities of Brazil. The causes of death avoidable with adequate health care were grouped into three: (1) ones avoidable through early diagnosis and treatment, (2) ones avoidable with improvements in the quality of treatment and medical care, and (3) ischemic heart disease. To evaluate the association between avoidable mortality and reorganization of the health care system, the period under study was divided into two subperiods: from 1983 through 1992 and from 1993 through 2002 (respectively, before and after approval of the operational guideline that served as the reference for the organization of the Unified Health System (Sistema Único de Saúde)). A negative binomial regression model that controlled for sex, age, geographic region, and socioeconomic conditions was used for the analysis. Results. During the period analyzed, 1 854 165 individuals between 0 and 74 years old died from avoidable causes in the municipalities studied. The multivariate analysis showed that, for all three groups of avoidable causes, the risk of avoidable mortality was higher in the 1983-1992 subperiod than in the 1993-2002 subperiod. For the entire 1983-2002 period, the risk was higher for males than for females, especially with respect to ischemic heart disease. Younger populations had lower risk. Higher socioeconomic level reduced the risk of death from avoidable causes, except for ischemic heart disease. Conclusions. Our results suggest that in Brazil the decrease in avoidable mortality from the 1983-1992 subperiod to the 1993-2002 subperiod was partially due to the changes in the availability of and access to health services brought about by the reorganization of the Brazilian health care system. [ABSTRACT FROM AUTHOR]

Objectives. Health care systems throughout the world are in the process of restructuring and reforming their health service delivery systems, reorienting themselves to a primary health care (PHC) model that uses multidisciplinary practice (MDP) teams to provide a range of coordinated, integrated services. This study explores the challenges of putting the MDP approach into practice in one community in a city in Canada. Methods. The data we analyzed were derived from a community-based participatory action research (CBPAR) project, conducted in 2004, that was used to enhance collaborative MDP in a PHC center serving a residential and small-business community of 11 000 within a medium-sized city of approximately 300 000 people in Canada. CBPAR is a planned, systematic approach to issues relevant to the community of interest, requires community involvement, has a problem-solving focus, is directed at societal change, and makes a lasting contribution to the community. We drew from one aspect of this complex, multiyear project aimed at transforming the rhetoric advocating PHC reform into actual sustainable practices. The community studied was diverse with respect to age, socioeconomics, and lifestyle. Its interdisciplinary team serves approximately 3 000 patients annually, 30% of whom are 65 years or older. This PHC center's multidisciplinary, integrated approach to care makes it a member of a very distinct minority within the larger primary care system in Canada. Results. Analysis of practice in PHC revealed entrenched and unconscious ideas of the limitations and boundaries of practice. In the rhetoric of PHC, MDP was lauded by many. In practice, however, collaborative, multidisciplinary team approaches to care were difficult to achieve. Conclusions. The successful implementation of an MDP approach to PHC requires moving away from physician-driven care. This can only be achieved once there is a change in the underlying structures, values, power relations, and roles defined by the health care system and the community at large, where physicians are traditionally ranked above other care providers. The CBPAR methodology allows community members and the health-related professionals who serve them to take ownership of the research and to critically reflect on iterative cycles of evaluation. This provides an opportunity for practitioners to implement relevant changes based on internally generated analyses. [ABSTRACT FROM AUTHOR]

Objective. To document the fact that differences in the treatment received by health services users in Mexico are mainly dependent on the type of provider, regardless of the users' socioeconomic status. Methods. The data were obtained by means of a survey of 18 018 users who visited 73 health services in 13 states within Mexico. They were asked to grade the way the institution had performed in seven of the eight domains that define appropriate user treatment (autonomy, confidentiality, communication, respectful manner, condition of basic facilities, access to social assistance networks, and free user choice). The questionnaire included some vignettes to help determine user expectations. A composite ordinal probit model was applied; the perception of quality in connection with each of the appropriate treatment domains was the independent variable, whereas gender, educational level, age, type of provider, and user expectations were used as control variables. Results. The type of provider was the main factor that determined users' perceptions regarding the treatment they received when visiting health services in Mexico. Institutions belonging to the social security system performed the worst, while the services provided under the program targeting the rural population (IMSS Oportunidades) received the highest scores. Overall, the domain that was most highly ranked was respectful manner, whereas the lowest score was given to the ability to choose the provider. Men felt they had been able to communicate better than women, while respectful manner, communication, and social support showed a significant negative association with educational level (P < 0.05). Conclusions. Differences were noted in the way different public health service providers in Mexico treat their users, regardless of the latter's socioeconomic status. Social security system providers showed the greatest deficiencies in this respect. Respectful manner was the domain that received the highest scores in the case of all providers. Organizational changes need to be made, since the shortcomings detected are not solely determined by factors related to health personnel, but also by certain aspects of the way the health system is structured in Mexico. [ABSTRACT FROM AUTHOR]

Discusses the abstract of "Improving the diabetes-patient encounter by reflective tutoring for staff," by Inger Hornstrom and colleagues published in the 2004 issue of the "Patient Education and Counseling" journal.