INGER/National Institute of Geriatrics

Description

The Mexico Flagship Site used the research infrastructure that was developed as part of the World Health Organization Integrated Care for Older People (WHO ICOPE) and the strengthening responses to dementia in developing countries initiatives (STRiDE). The site’s program recruited participants over the age of 60 from six participating primary care sites belonging to Mexico City’s Ministry of Health Services. Digital cognitive assessments (DCAs) were conducted by frontline healthcare providers, and blood-based biomarker (BBM) tests were conducted and disclosed by specialists at INGER (National Institute of Geriatric Research).

Mexico has a mixed healthcare system that offers both public and private options. The public system, administered by the Mexican Social Security Institute (IMSS) and the Mexican Institute of Social Security and Services (ISSSTE), provides coverage to formal private and public sector employees, respectively. The Ministry of Health (SSA) provides health services for the uninsured. Private healthcare is available mostly by out-of-pocket payments for those who can afford it.

What are the key lesson learned for the site?

Working within set institutional pathways requires navigation.

Moving from research to implementation in real-life healthcare clinics, the Mexico site had to carefully navigate the complexities of long-standing pathways and methods of doing things. The site team learned to communicate and plan with top authorities and decision-makers focusing on managing complex processes and expectations of multiple stakeholders. This was true not only in setting up the care model, but in ensuring referrals to the third-level hospitals for confirmation of dementia diagnostics to all participants with cognitive impairment results from the DCA tool.

Goal 1: Evaluate your healthcare system context.

Choosing sustainable and scalable tools.

Some of the Mexico sites faced infrastructural challenges such as lack of technology (e.g., some clinics only had one computer or printer, and poor Wi-Fi connectivity). To work around these challenges, the Mexico site opted to use tablets with mobile data to conduct DCAs, which offered more reliable internet access.

Goal 5: Select your cognitive assessment tools.

Local customization of cognitive assessment

The site used locally approved consent forms for participants to conform to Ethics Committees at INGER and Mexico City’s MoH. Along with having the DCA interface translated to Spanish, the Mexico site supported LINUS in translating the DCA scoring algorithm into Spanish. Additionally, the site collaborated with the product owner to customize the words in the tests to better fit the local context and conducted a usability testing in Mexico City. While this process added to the workload of the team and project timelines it ensured the optimal setup and use of the DCA in the local setting.

Goal 5 Select your cognitive assessment tools.