Improving cardiovascular health with the patient-centered, integrated primary care HEARTS model in Trinidad and Tobago

• Published in: Revista panamericana de salud pública Vol. 46; no. 169; pp. e169 - 6
• Main Authors: Doon, Rohit, Malcolm, Taraleen, Lewis, Yvonne, Holder, Latifah, Gulston, LaDonna, Hamid, Abdul, Best, Allana, Mitchell, Roxanne, Lalla, Pedram
• Format: Journal Article
• Language: English
• Published: United States Organización Panamericana de la Salud 01.01.2022; Pan American Health Organization
• Subjects: Brief Communication; cardiovascular disease; Health Policy & Services; health systems; patient-centered care; primary health care; trinidad and tobago; Cardiovascular disease; Trinidad and Tobago; primary health care; health systems; patient-centered care; assistência centrada no paciente; Doenças cardiovasculares; atención primaria de salud; atenção primária à saúde; atención dirigida al paciente; Trinidad y Tobago; sistemas de saúde; Trinidad e Tobago; Enfermedades cardiovasculares; sistemas de salud
• DOI: 10.26633/RPSP.2022.169
• ISSN: 1020-4989; 1680-5348

This article describes the introduction of the Pan American Health Organization's HEARTS in the Americas program in Trinidad and Tobago and the successful experiences and challenges encountered in introducing and scaling it up as a strategy for strengthening the health system's response to cardiovascular diseases. Evidence about implementation of the HEARTS program in the World Health Organization's Region of the Americas was reviewed to identify the progress made, barriers, success factors and lessons learned. In 2019, the Ministry of Health commenced implementation of the program in 5 (4.9%) of the 102 primary health care centers, and by the end of 2021, it had been scaled up to 46 (45.0%) centers. The HEARTS program ensures that patients' cardiovascular health is managed in a comprehensive way through providing counseling about a healthy lifestyle, using evidence-based treatment protocols, ensuring access to essential medicines and technologies, and using a risk-based team approach, a monitoring and evaluation system and also a team-based approach to care delivery. The barriers encountered during implementation included the fragmentation of the existing health care system, the paternalistic role assumed by health care professionals, the resistance of some health care workers to change and a lack of team-based approaches to providing care. Successful implementation of the program was enabled through ensuring high-level political commitment, establishing the national HEARTS Oversight Committee, ensuring stakeholder involvement throughout all phases and implementing standardized approaches to care. When implemented in the context of existing primary health care settings, the HEARTS program provides an exceptionally well integrated and comprehensive model of care that embodies the principles of universal health care while ensuring the health of both populations and individuals. Thus, it enables and promotes a strengthened primary health care system and services that are responsive and resilient.