Quality and performance of primary care for chronic conditions in Mendoza: population-based findings

Chronic conditions (CC) require continuous, coordinated primary health care (PHC), yet Argentina's health system, including Mendoza province, remains fragmented across public, social security, and private subsectors. Evidence on how people with CC (PwCC) experience this fragmented system is limited. This study compared individuals with and without CC using the People's Voice Survey (PVS) in Mendoza.

Cross-sectional, population-based telephone survey in Mendoza province (September-November 2022). From a random sample of 30 000 phone numbers, 1188 adults completed the survey. Weighted analyses compared PwCC and those without (non-PwCC) across domains of healthcare access, use, quality of care, user experience, and confidence in the system.

Of respondents, 41% reported ≥1 CC. PwCC had higher healthcare utilization (92.8% vs. 82.2% with ≥1 visit in the past year; P < .001) and were more likely to have a usual source of care (87.0% vs. 80.8%; P = .008), with a greater proportion attached to secondary-level facilities (42% vs. 35%; P < .05). Yet unmet need was also more prevalent among PwCC (22.8% vs. 17.5%; P = .046), driven primarily by long wait times. PwCC rated interpersonal dimensions of their most recent visit more favourably: clear communication (60.5% vs. 52.2%; P = .013), staff dedication (57.2% vs. 49.2%; P = .017), and kindness (56.9% vs. 49.8%; P = .035); yet more frequently reported a perceived medical error (84.3% vs 90.4% reporting no error; P = .003). Mental health needs were more prevalent among PwCC (17.5% vs. 11.6%; P = .007); more PwCC received mental healthcare in the past year (20.2% vs. 10.6%; P < .001), but the proportion with unmet mental health needs was similar across groups (P = .83). Cancer screening rates were similarly low across groups. Confidence in obtaining and affording good-quality care was low across both groups (31%-33%). Together, these patterns reveal a contact-quality-access paradox: greater system engagement and better-rated interpersonal care among PwCC coexist with greater unmet need, more perceived medical errors, and no advantage in financial confidence.

Improving health system performance for PwCC requires addressing structural and interpersonal dimensions of care. Strengthening PHC as the foundation for CC management, integrating preventive and mental health services, and building mechanisms for accountability and public input are priority actions.