Rubinstein Adolfo L, Irazola Vilma E, Poggio Rosana, Gulayin Pablo, Nejamis Analía, Beratarrechea Andrea
South American Center of Excellence for Cardiovascular Health, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
South American Center of Excellence for Cardiovascular Health, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
Glob Heart. 2015 Mar;10(1):21-9. doi: 10.1016/j.gheart.2014.12.011.
In Argentina, cardiovascular diseases cause an estimated 100,000 deaths and more than 250,000 coronary heart disease and stroke events annually, at a cost of more than $1 billion international dollars. Despite progress in the implementation of several programs to combat noncommunicable diseases in Argentina over the past few years, most health resources are still dedicated to infectious diseases and maternal and child health. The Institute for Clinical Effectiveness and Health Policy, an independent academic institution affiliated with the University of Buenos Aires medical school, runs the South American Centre of Excellence in Cardiovascular Health (CESCAS), a center devoted to epidemiology, implementation, and policy research. At the CESCAS, there are 3 ongoing randomized clinical trials focused on implementation science: 1) a mobile health intervention, for preventing the progression of prehypertension in low-income, urban settings in Argentina, Guatemala, and Peru; 2) a comprehensive approach to preventing and controlling hypertension in low-resource settings in Argentina; and 3) an educational approach to improving physicians' effectiveness in the detection, treatment, and control of hypercholesterolemia and high cardiovascular disease risk in low-resource settings in Argentina. All of these trials involve the design and implementation of complex interventions for changing the behaviors of providers and patients. The rationale of each of the 3 studies, the design of the interventions, and the evaluation of processes and outcomes are described in this article, together with the barriers and enabling factors associated with implementation-research studies. There is a strong need in Argentina and all of Latin America for building the health-research capacity and infrastructure necessary for undertaking implementation studies that will translate evidence from research findings into improvements in health policy and practice with regard to cardiovascular diseases and their risk factors.
在阿根廷，心血管疾病估计每年导致10万人死亡，以及超过25万例冠心病和中风事件，造成的损失超过10亿美元国际货币单位。尽管在过去几年里阿根廷实施了多个防治非传染性疾病的项目并取得了进展，但大多数卫生资源仍用于传染病以及母婴健康方面。临床疗效与卫生政策研究所是一所与布宜诺斯艾利斯大学医学院相关联的独立学术机构，运营着南美心血管健康卓越中心（CESCAS），该中心致力于流行病学、实施和政策研究。在CESCAS，有3项正在进行的聚焦于实施科学的随机临床试验：1）一项移动健康干预措施，用于预防阿根廷、危地马拉和秘鲁低收入城市地区的高血压前期进展；2）一种在阿根廷资源匮乏地区预防和控制高血压的综合方法；3）一种教育方法，用于提高阿根廷资源匮乏地区医生在检测、治疗和控制高胆固醇血症以及高心血管疾病风险方面的效果。所有这些试验都涉及设计和实施复杂干预措施以改变医护人员和患者的行为。本文描述了这3项研究各自的基本原理、干预措施的设计以及过程和结果的评估，同时还介绍了与实施研究相关的障碍和促进因素。阿根廷乃至整个拉丁美洲都迫切需要建设开展实施研究所需的卫生研究能力和基础设施，这些研究将把研究结果中的证据转化为心血管疾病及其危险因素在卫生政策和实践方面的改善。
