Browsing by Author "Rivera, Marcela"

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    Candidate Interventions for Integrating Hypertension and Cardiovascular-Kidney-Metabolic Care in Primary Health Settings: HEARTS 2.0 Phase 1
    (2025) Rosende, Andres; Romero, Cesar; DiPette, Donald; Brettler, Jeffrey; Van der Stuyft, Patrick; Satheesh, Gautam; Perel, Pablo; Chapman, Niamh; Moran, Andrew; Schutte, Aletta; Sharman, James; Irazola, Vilma; Huffman, Mark; Campbell, Norm; Salam, Abdul; Lanas, Fernando; Coca, Antonio; Garcia, Sebastian; Ferreiro, Alejandro; Lopez, Patricio; Rico, Jorge; Ridley, Emily; Picone, Dean; Flood, David; Piñeiro, Daniel; Neira, Carolina; Rodriguez, Gonzalo; Wellmann, Irmgardt; Orias, Marcelo; Rivera, Marcela; Villatoro, Matías; Onuma, Oyere; Ramroop, Shaun; Khan, Taskeen; Valdes, Yamile; Kunz, Weimar; Plavnik, Frida; Zuniga, Eric; Grassani, Ana; Tajer, Carlos; Zaidel, Ezequiel; Marin, Marcos; Cyr-Philbert, Shana; Amorin, Ignacio; Diaz, Miguel; Bortolotto, Luiz; Avezum, Alvaro; Ribeiro, Antonio; Tobe, Sheldon; Aumala, Teresa; Angell, Sonia; Lavados, Pablo; Ouriques, Sheila; Munera, Ana; Jaffe, Marc; Prabhakaran, Dorairaj; Parati, Gianfranco; Zhang, Xin Hua; Rodgers, Anthony; Yusuf, Salim; Whelton, Paul; Ordunez, Pedro
    Background: HEARTS in the Americas is the regional adaptation of the WHO Global HEARTS Initiative, aimed at helping countries enhance hypertension and cardiovascular disease (CVD) risk management in primary care settings. Its core implementation tool, the HEARTS Clinical Pathway, has been adopted by 28 countries. To improve the care of hypertension, diabetes, and chronic kidney disease (CKD), HEARTS 2.0 was developed as a three-phase process to integrate evidence-based interventions into a unified care pathway, ensuring consistency across fragmented guidelines. This paper focuses on Phase 1, highlighting targeted interventions to improve and update the HEARTS Clinical Pathway. Methods: First, the coordinating group defined the project's scope, objectives, principles, methodological framework, and tools. Second, international experts from different disciplines proposed interventions to enhance the HEARTS Clinical Pathway. Third, the coordinating group harmonized these proposals into unique interventions. Fourth, experts appraised the appropriateness of the proposed interventions on a 1-to-9 scale using the adapted RAND/UCLA Appropriateness Method. Finally, interventions with a median score above 6 were deemed appropriate and selected as candidates to enhance the HEARTS Clinical Pathway. Results: Building on the existing HEARTS Clinical Pathway, 45 unique interventions were selected, including community-based screening, early detection and management of risk factors, lower blood pressure thresholds for diagnosing hypertension in high-CVD-risk patients, reinforcement of single-pill combination therapy, inclusion of sodium-glucose cotransporter-2 inhibitors for patients with diabetes, CKD, or heart failure, expanded roles for non-physician health workers in team-based care, and strengthened clinical documentation, monitoring, and evaluation. Conclusion: HEARTS 2.0 Phase 1 identifies key interventions to integrate and improve hypertension and cardiovascular-kidney-metabolic care within primary care, enabling their seamless incorporation into a unified and effective clinical pathway. This process will inform an update to the HEARTS Clinical Pathway, optimizing resources, reducing care fragmentation, improving care delivery, and advancing health equity, thereby supporting global efforts to combat the leading causes of death and disability.
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    Creencias frente a la utilización de métodos anticonceptivos reversibles de larga duración (LARCS) en mujeres entre 18 y 25 años, usuarias del CESFAM Gabriela Mistral, entre agosto y noviembre del año 2019
    (Universidad del Desarrollo. Facultad de Medicina. Escuela de Enfermería, 2019) Carrasco, Daniela; González, Francisca; Martini, Javiera; Otaíza, Macarena; Rivera, Marcela; Carrasco, Daniela; González, Francisca; Martini, Javiera; Otaíza, Macarena; Rivera, Marcela; Riquelme, Giselle; Riquelme, Giselle
    Existen creencias que generan un entorno restrictivo para la utilización de anticonceptivos de larga duración (LARCs), provocando su no uso, pese a ser los más eficaces. El objetivo general es describir las creencias frente a la utilización de LARCs en mujeres entre 18 y 25 años, usuarias del CESFAM Gabriela Mistral, de agosto a noviembre del año 2019. El estudio es cualitativo colectivo y la muestra fue dirigida y por conveniencia. Se realizó entrevistas, las que se analizaron de forma temática descriptiva. Pese a la alta efectividad y beneficios reconocidos por las participantes; existen barreras de falta de conocimiento, experiencias de terceros y mitos; los que generan inseguridad y llevan al no uso de LARCs. Los hallazgos coinciden con la evidencia, entrevistadas destacan eficacia de los LARCs; literatura muestra que proporcionan bajas tasa de embarazo y mujeres los prefieren por la poca manipulación usuaria. Sin embargo, experiencias negativas, falta de conocimiento y los mitos generan malentendidos que llevan al no uso. Entrevistadas destacan que a falta de conocimiento y mitos, son una barrera para el uso de LARCs. La enfermera desempeña un rol en la promoción y prevención, puede realizar derivaciones a expertos.

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