RESUMO
Introduction: Given the progressive aging of the population, there is an urgent need at the health system level to implement effective models to care for older people (OP). Healthy aging is imperative to reach the Sustainable Development Goals. The World Health Organization (WHO) developed the Integrated Care for Older People (ICOPE) strategy to address this challenge. Implementing ICOPE requires its adaption to a specific context. We propose a pathway for such adaptation through an evaluation of the design of ICOPE; thus, we aim to describe the Theory of Change (ToC) of ICOPE and evaluate it for its implementation in Mexico City. Methods: Based on the WHO and published literature documentation, we drafted an initial ToC for ICOPE. Then, we validated the ToC with experts in ICOPE, after which we evaluated and refined it by discussing the causal pathway, intervention required to activate it, rationale, and assumptions in consecutive workshops with 91 stakeholders and healthcare workers, using the nominal group technique to reach a consensus. Results: The resulting ToC has the potential to contribute to healthy aging by three expected impacts: (1) prevention, reversal, or delaying of the decline of intrinsic capacity (IC) in OP; (2) improvement of the quality of life of OP; and (3) increase of disability-free life expectancy. The ICOPE causal pathway had ten preconditions, including the availability of resources, identifying at-risk individuals, available treatments, and evaluating results. Discussion: We adapted ICOPE to a specific implementation context by evaluating its ToC in a participatory process that allows us to identify challenges and address them, at least in terms of the guidelines to operate the strategy. As ICOPE is an approach for a primary healthcare system, its adoption in a community healthcare program is promising and feasible. Evaluation as a tool could contribute to the design of effective interventions. The evaluation of the design of ICOPE for its implementation contributes to the strength of its potential to improve care for OP. This design for implementing ICOPE has the potential to be applied to similar contexts, for example, in other lower-middle-income countries.
RESUMO
AIM: To evaluate the readiness of the Mexican healthcare system to implement the integrated care for older people (ICOPE) approach into an existing healthcare model. METHODS: We conducted a cross-sectional study with data from 2473 healthcare workers analyzed using the model for understanding success in quality (MUSIQ) framework to gather data from healthcare professionals. Their perceptions regarding the readiness for ICOPE were assessed across five dimensions: team, microsystem, infrastructure, organization, and external environment. RESULTS: Only 717 (29%) of the participants believed ICOPE could be successfully implemented in Mexico without any modifications. A total of 1261 (51%) participants rated the readiness of ICOPE with some barriers. The main barriers were reallocating resources and the external environment. OBSERVATION: Mexico's healthcare system faces barriers to innovation that could hinder the successful integration of the ICOPE approach. A systematic identification of these barriers provides an opportunity to suggest adaptations and refinements to increase the probability of success. Using the contextual factors identified as facilitators and the proposal of interventions such as the ICOPE app could improve the chances of success. CONCLUSION: The participants of this study evaluated ICOPE as ready to implement, with some contextual barriers. The readiness evaluation supports the stakeholders' and policymakers' decisions in implementing and monitoring the program in a natural setting. Evaluating the readiness of the intervention increases the possibility of aligning the innovation with contextual factors, increasing the chances of its successful adoption and implementation.