Performance of a national primary care chronic disease screening strategy in Chile: a mixed-methods analysis

Abstract

Abstract Introduction The continuous increase in chronic non-communicable diseases requires strengthening primary care preventive strategies. In Chile, preventive health screening is a national strategy focused on identifying adults with risk factors, including hypertension, diabetes, and dyslipidemia, among others. It is broadly implemented in primary care and has associated performance resources. Objective To evaluate the performance of Chile’s primary care preventive health screening for adults and describe healthcare professionals' perceptions regarding its implementation. Methods: A parallel convergent mixed-methods study was conducted. The quantitative component employed a retrospective cohort study to assess individuals between 15 and 64 years old who received a preventive health screening in primary care during 2023. Data analysis focused on access and waiting times of the screening pathways. The qualitative component consisted of an online survey to evaluate participants' perceptions of the screening pathways' performance. Results A total of 36,207 adult individuals received a preventive health screening during 2023, of which 61.5% were reported as completed. Screenings with the highest completion rates (between 99% and 80.1%) were those performed during the check-up day: high blood pressure, overweight and obesity, alcohol consumption, and smoking. Access to the second and third steps declines abruptly, with rates between 61.4% and 39.3%, including breast and cervical cancer screenings. The lowest access was to dyslipidemia and diabetes mellitus type two screening. Mean waiting times range from 16 to 179 days. The shortest times were from the screening to the first measure of the high blood pressure study and the pap smear test (16 and 18 days, respectively). The longest times were for diagnostic cardiovascular diseases (129 to 179 mean days). Qualitative findings identified that providers perceived that individuals are frequently lost when the screening pathway requires multiple steps, and highlighted the need to develop screening pathway protocols and implement strategies to manage the screening pathway proactively. Conclusion This is the first evaluation of Chile’s preventive health screening, demonstrating high implementation but dramatically low completion rates of diagnostic actions after the screening. The policy urgently needs to ensure active follow-up throughout the diagnostic pathway, which can lead to early diagnosis and prevent avoidable complications of cardiovascular disease and cancer.

Keywords

• Preventive health check-up
• Screening pathways
• Non-communicable chronic diseases
• Primary care
• Health system performance
• Chile