Early Detection of Chronic Kidney Disease in Mexico, a Case for Policy Transfer

Rosalia Estephanie Mejia-Avila,1,* Ofelia Poblano-Verástegui,2,* Juan Alfredo Tamayo y Orozco,3,* Alfonso M Cueto-Manzano,4,* Emanuel Orozco Núñez2,* 1School of Public Health of Mexico, Cuernavaca, Morelos, Mexico; 2National Institute of Public Health of Mexico, Cuernavaca, Morelos, Mexico; 3AcceSalud, Mexico City, Mexico; 4Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Mexico*These authors contributed equally to this workCorrespondence: Emanuel Orozco Núñez, Health Systems Research Centre, National Institute of Public Health, Av. Universidad No. 655 Colonia Santa María Ahuacatitlán Cerrada Los Pinos y Caminera, Cuernavaca, Morelos, CP 62100, Mexico, Tel +52 (777)329 3000 ext 5328, Email [email protected]: Chronic kidney disease (CKD) treatment is often delayed in many countries, creating challenges for the health system. Therefore, it is necessary to strengthen its detection and management from the early stages. Local experiences that have been successful in managing CKD could transfer their policies and thus systematically expand the scope of their organizational learning.Purpose: To characterize the elements of a success story of early detection and care of CKD in an adult population with social security, in order to transfer it to a similar organization.Patients and Methods: Qualitative study of organizational nature, exploratory, descriptive, and analytical. It consisted of a narrative review, documentation of the process in a primary care unit of a social security institution in Jalisco, Mexico, and a flowchart linking the primary components. The analysis followed the questions used in the design of integrated care pathways.Results: The literature review highlighted that early detection should be targeted at groups at risk for developing CKD, defining the clinical tests necessary to monitor and stage CKD, as well as management by a multidisciplinary team and the use of nephroprotective drugs. The case characterization provided insight into the institutional context in which the care process for patients with risk factors for CKD takes place. By incorporating the results of the review into the clinical care process, an ideal process for early detection of CKD was developed.Conclusion: This research allowed the incorporation of elements of the institutional context in the characterization of the process of early detection and care of CKD, systematically identifying organizational and clinical elements that can promote the transfer of this process to other contexts.Keywords: policy transfer, early detection, chronic kidney disease, social security, Mexico