From fragmentation to integration: Patient-reported access to cardiovascular care in Colombia’s primary health system

Objective: To assess patient-reported experiences of access to services along the Cardio-Cerebrovascular and Metabolic Comprehensive Healthcare Pathways (CVD-RIAS) among patients with hypertension and/or diabetes in two primary health care networks in Bogotá, highlighting achievements and identifying remaining challenges to integrated care. Methods: Cross-sectional descriptive analysis using baseline data from patients with confirmed hypertension and/or type 2 diabetes enrolled in CVD-RIAS. In-person surveys and linked clinical records were used to examine access experiences across consultations, tests, prescriptions, and medication delivery. Results were stratified by age, education, income, and Charlson Comorbidity Index. Results: Of 1 258 patients, 85.5% reported no access issues for hypertension or diabetes care. Most (80%) rated contact frequency positively; most contacted were general physicians and pharmacies. Most patients contacted at least one professional (99.6%), received diagnostic tests (88%,) and obtained some or all prescribed medications (97.3%). Sixty percent accessed specialists, mostly through the assigned network. Median specialist wait was two months, longer for high-risk and higher-income patients. Perceptions were split: 45% found wait times reasonable, 45% did not. Ratings of contact frequency, wait times, and access to referred services varied by sociodemographic characteristics. Overall, patient care pathways were aligned with milestones defined in CVD-RIAS. Conclusions: The CVD-RIAS model is achieving goals of expanding access to services, aligning care delivery with clinical risk, and fostering positive patient experiences. These findings reflect progress toward risk-based, integrated service delivery. Remaining gaps - incomplete medication supply and difficulties accessing referred services - underscore the need for efforts to enhance coordination and equity.