Cancer survivorship needs in Brazil: Patient and family perspective.

INTRODUCTION: Cancer Survivorship is a growing public health challenge. Effective responses from health care and social services depend on appropriate identification of survivors and their families´ specific needs. There are few studies on survivorship in low and middle-income countries, therefore, more evidence-based studies are necessary to develop a comprehensive approach to cancer survivorship. OBJECTIVES: Identify the needs of cancer survivors and their relatives, specifically those of individuals with breast, cervical or prostate cancer, and with acute lymphocytic leukemia (ALL). METHODS: A qualitative, exploratory study conducted in two referral institutions in Brazil, located in Rio de Janeiro (Southeast region) and Fortaleza (Northeast region). The study included 47 patients of public and private health services and 12 family members. We used script-based semi-structured interviews. The discursive material obtained was categorized and analyzed using the Thematic Analysis approach. RESULTS: The analysis identified three central themes: 1) consequences of cancer treatment; 2) Changes in daily life associated with cancer survivorship; and 3) Unmet structural needs in cancer survivorship. CONCLUSION: Social and cancer control policies in Brazil should provide resources, specific care standards and clinical, psychological and social support. Cancer survivors should also receive rehabilitation and work reintegration guidelines. This matter requires broader access to qualified cancer information, development of an integrated patient-centered care and care model, and more research resources for the country's post-treatment cancer period.

Self-identity, lived experiences, and challenges of breast, cervical, and prostate cancer survivorship in Mexico: a qualitative study.

BACKGROUND: Qualitative research on cancer patients' survivor-identity and lived experiences in low- and middle-income countries is scarce. Our study aimed at exploring the concept and experience of survivorship for Mexicans living with breast, cervical, and prostate cancer. METHODS: We conducted a qualitative study in Mexico City, Morelos, Nuevo León, and Puebla. The participants were breast, cervical, and prostate cancer patients ≥18 years of age with completed primary cancer treatment. Data were collected via in-depth interviews and analyzed using an inductive thematic approach. RESULTS: The study included 22 participants with a history of breast, 20 cervical, and 18 prostate cancer. Participants accepted the term "cancer survivor" as a literal interpretation of being alive, medical confirmation of treatment completion, or achievement of a clinical result possibly indicative of cure. The majority of respondents perceived that the future is out of their control and under God's will. They linked cure to divine intervention and did not demonstrate the sense of empowerment that is often associated with the survivorship term. The principal themes of their narratives encompass: 1) adverse physical and sexual experiences; 2) emotional problems; 3) cancer-related stigma; 4) challenges to obtaining health-related information; 5) financial hardship; and 6) experience of strengthening family ties in order to provide them with support. In addition, women with breast cancer reported distress caused by changes in body image and positive experience with support groups. CONCLUSION: In Mexico, cancer patients report complex survivorship experiences that demand post-treatment follow-up and support. There is the need to implement comprehensive, culturally-relevant survivorship programs focused on emotional, informational, and in-kind support and empowerment of cancer patients.

Psychosocial needs of young breast cancer survivors in Mexico City, Mexico.

OBJECTIVE: Young breast cancer survivors in Mexico face distinct psychosocial challenges that have not been characterized. This study aims to describe the psychosocial needs of young breast cancer survivors in Mexico at 5 or more years of survivorship, identifying areas of focus for early interventions. METHODS: Breast cancer patients diagnosed at age 40 or prior with 5 or more years since diagnosis were invited to participate in one-on-one 30-60 minute semi-structured audio-recorded interviews at the Instituto Nacional de Cancerología in Mexico City. Transcripts were coded using thematic analysis with NVivo software. RESULTS: 25 women participated. Five major phenomena emerged from analysis: (1) minimization of fertility concerns; (2) persistence of body image disturbance over time; (3) barriers to employment during survivorship; (4) impact on family relationships and social networks; & (5) unmet psychological care and informational needs. CONCLUSIONS: Early interventions with a focus on fertility loss education, access to reconstructive surgery and body image support, guidance during return-to-work, assistance with childcare, integration of psychological care and the fulfillment of informational needs could ameliorate long-term psychological and social distress for young breast cancer survivors in Mexico.

Training Primary Health Professionals in Breast Cancer Prevention: Evidence and Experience from Mexico.

To analyze the key successful factors of a national educational strategy for early breast cancer detection developed in Mexico for primary health care personnel from 2008 to 2014, an educational strategy to train physicians, nurses, health promoters, and medical students from local ministries of health with a competency-based approach was developed and implemented using diverse educational modalities, face-to-face, blended, and a massive open online course (MOOC). Formative and summative evaluations were used during the implementation of the course. A total of 19,563 health professionals were trained from 2008 to 2014. The graduation rate, an average of all educational modalities, was 91 %, much higher than those previously reported in the literature. The factors that might have influenced this success were (1) the training strategy, which was designed according to the characteristics and specific needs of the target groups; (2) the political will and commitment of the country's health authorities; (3) the technological and educational models used; and (4) the punctual follow-up of participants. This study shows that carefully designed educational interventions can improve service professionals' competencies and that regardless of the modality, face-to-face, blended learning, or MOOC, high graduation rates can be achieved. Further evaluation is required to demonstrate that the competencies remained in all target groups after 6 months of the intervention and that the women served by the trained personnel were provided accurate information and timely diagnoses of breast cancer.

Special Needs of Young Women with Breast Cancer in Limited Resource Settings.

BACKGROUND: Young women with breast cancer (YWBC) comprise a group of patients with unique biopsychosocial characteristics with a special perception of needs throughout their disease and survivorship. Contexts marked by restricted allocations and economic constraints might further aggravate the struggle of these patients living within limited resource settings and can demand added requirements for them and their families. OBJECTIVE: To analytically explore the existing knowledge regarding the needs of YWBC in low- and middle- income countries (LMICs). METHODS: We conducted a thorough literature review of scientific journal databases available in Spanish and English containing information on YWBC in LMICs. RESULTS: We did not find any publications exclusively assessing this topic in resource-limited settings. We looked for data on the different types of YW need from studies in the region that assessed the needs of breast cancer (BC) patients in general and described in their findings the particularities of young patients. Young BC patients described within the literature present a variety of needs. Those reported most frequently as unmet were related to information needs and psychological counseling, practical and physical assistance, and social and spiritual support. CONCLUSIONS: Published literature on the subject - particularly in Latin America - is extremely scarce. This offers an area of opportunity for conducting further research in this topic that would help improve health professional training and establish health policies in favor of YWBC.

The burden of cancer in Mexico, 1990-2013.

OBJECTIVE: To analyze mortality and incidence for 28 cancers by deprivation status, age and sex from 1990 to 2013. MATERIALS AND METHODS: The data and methodological approaches provided by the Global Burden of Disease (GBD 2013) were used. RESULTS: Trends from 1990 to 2013 show important changes in cancer epidemiology in Mexico. While some cancers show a decreasing trend in incidence and mortality (lung, cervical) others emerge as relevant health priorities (prostate, breast, stomach, colorectal and liver cancer). Age standardized incidence and mortality rates for all cancers are higher in the northern states while the central states show a decreasing trend in the mortality rate. The analysis show that infection related cancers like cervical or liver cancer play a bigger role in more deprived states and that cancers with risk factors related to lifestyle like colorectal cancer are more common in less marginalized states. CONCLUSIONS: The burden of cancer in Mexico shows complex regional patterns by age, sex, types of cancer and deprivation status. Creation of a national cancer registry is crucial.

Breast cancer policy in Latin America: account of achievements and challenges in five countries.

BACKGROUND: The recent increase of breast cancer mortality has put on alert to most countries in the region. However it has taken some time before breast cancer could be considered as a relevant problem. Only in recent years breast cancer has been considered a priority in some Latin American countries and resources have been mobilized to confront the problem at the institutional level. The article analyzes the efforts made in five Latin American countries (Argentina, Brazil, Colombia, Mexico and Venezuela) in the last 15 years to design and implement policies to address the growing incidence of breast cancer. METHODS: Data was collected between July and December 2010 from both primary and secondary sources. Semi-structured interviews were conducted with key informants from governmental and non-governmental organizations. Secondary data was obtained from publications in journals, government reports and official statistics in each country. Analysis combines information from both types of sources. RESULTS: Countries have followed different paths and are in different stages of policy implementation. In all cases early detection is a key strategy. Through the design of programs and guidelines, the allocation of financial resources to treat patients, as well as a formally structured information system, Brazil and Mexico have been able to set up comprehensive national policies. Argentina, Colombia and Venezuela have made important advancements but not yet capable of coordinating comprehensive national policies. CONCLUSION: Breast cancer is being considered a priority in all five countries but there are different stages in the rolling out of comprehensive national policies due to differences in their capacity to allocate resources, implement operational strategies and encourage the participation of relevant stakeholders.

The burden of cancer in Mexico, 1990-2013 / La carga del cáncer en México, 1990-2013

Abstract: Objective: To analyze mortality and incidence for 28 cancers by deprivation status, age and sex from 1990 to 2013. Materials and methods: The data and methodological approaches provided by the Global Burden of Disease (GBD 2013) were used. Results: Trends from 1990 to 2013 show important changes in cancer epidemiology in Mexico. While some cancers show a decreasing trend in incidence and mortality (lung, cervical) others emerge as relevant health priorities (prostate, breast, stomach, colorectal and liver cancer). Age standardized incidence and mortality rates for all cancers are higher in the northern states while the central states show a decreasing trend in the mortality rate. The analysis show that infection related cancers like cervical or liver cancer play a bigger role in more deprived states and that cancers with risk factors related to lifestyle like colorectal cancer are more common in less marginalized states. Conclusions: The burden of cancer in Mexico shows complex regional patterns by age, sex, types of cancer and deprivation status. Creation of a national cancer registry is crucial.

Resumen: Objetivo: Analizar la incidencia y la mortalidad de 28 tipos de cáncer por nivel de marginación, grupos de edad y sexo, de 1990 a 2013. Material y métodos: Los datos utilizados provienen del estudio de la Carga Global de Enfermedades (2013). Las entidades federativas se clasificaron de acuerdo con el índice de marginación del Consejo Nacional de Población. Resultados: Los datos muestran una tendencia decreciente para algunos cánceres (pulmón y cervical), mientras otros aparecen como prioritarios y relevantes (próstata, mama, estómago, colon e hígado). En el norte se observan incrementos regionales mayores en las tasas de incidencia y mortalidad estandarizadas por edad, mientras que en los estados del centro se observa una tendencia decreciente de la tasa de mortalidad. Conclusiones: La epidemiología del cáncer en México (en su mayoría basada en datos de mortalidad) presentan patrones regionales complejos por edad, sexo, tipo de cáncer e índice de marginación. Es vital la creación de un registro nacional para mejorar el seguimiento y evaluación de intervenciones preventivas y curativas.

Costs of breast cancer care in Mexico: analysis of two insurance coverage scenarios.

BACKGROUND: Breast cancer (BC) is a major cause of disease and death worldwide. In addition to its contribution to mortality and disability, it is a major economic burden both public and private. OBJECTIVE: To estimate the average direct medical cost/year of care for the diagnosis and treatment of BC in two coverage scenarios in Mexico: What is 'ideal' based on service usage patterns according to international guidelines and what is 'current' using the service usage patterns of suppliers in Mexico. MATERIAL AND METHODS: The pattern and intensity of use of procedures for the care of BC in the Mexican Social Security Institute (IMSS) for 2009 were identified and prices were associated using the guidelines from the System of Social Protection in Health (SPSS) and the IMSS for the current scenario and the ideal scenario, international patterns (Breast Health Global Initiative BHGI after its acronym in English) were used and prices were associated from the SPSS guidelines. RESULTS: The annual average direct medical cost per patient in the 'current' scenario was 8557 US$, while the cost in the 'ideal' scenario was 4554 US$. There are differences in costs between 'what we do' and 'what should be done', due to differences in the implementation of the interventions for the treatment of the different stages of the disease. A proportional increase in the average cost was also identified as the diagnosis stage advanced (from I to III). CONCLUSIONS: Given that in Mexico there is universal insurance coverage for the treatment of BC, it is necessary to use economic resources more efficiently. It is necessary to continue to examine this topic in more depth and the next step will be to assess the effectiveness of both scenarios in order to provide enough evidence for the decision-making process.

Tendencia de la mortalidad por trastornos mentales: un panorama epidemiológico en México (1980-2011) / Tendency of mortality due to mental disorders: an epidemiologic view (Mexico, 1980-2011)

Resumen Se presentan resultados que buscan caracterizar el panorama epidemiológico sobre la tendencia de la mortalidad derivada de enfermedades mentales, específicamente psicosis alcohólica, ocurrido en los últimos 30 años, en la República Mexicana.

Abstract Here we present the results that show the tendency in mortality due to mental disorders, specifically alcohol-related psychosis, in the last 30 years in Mexico.

El Fondo de Protección contra Gastos Catastróficos: tendencia, evolución y operación / Fund for Protection against Catastrophic Expenses

OBJETIVO. Documentar los procesos operativos y de gestión del Fondo de Protección contra Gastos Catastróficos (FPGC), evolución y distribución del gasto y explorar semejanza entre padecimientos cubiertos y perfil epidemiológico. MATERIAL Y MÉTODOS. Estudio mixto, de naturaleza gerencial, que incluyó entrevistas semiestructuradas, revisión de bases de datos de la Comisión Nacional de Protección Social en Salud (CNPSS), egresos hospitalarios y mortalidad. RESULTADOS. El 52 por ciento de los estados tardan el doble del tiempo establecido para notificar y validar los casos. De 2004 a 2009 el FPGC pasó de 6 a 49 intervenciones, equivalente a un incremento nominal y real del gasto de 2 306.4 y 1 659.3 por ciento, respectivamente. La intervención priorizada fue VIH/SIDA con 39.3 por ciento; el Distrito Federal obtuvo la mayor proporción del gasto (25.1 por ciento). Algunas de las principales causas de mortalidad son cubiertas por el FPGC. CONCLUSIONES. La revisión de los criterios de inclusión de enfermedades y la adecuación del fondo para atender la demanda creciente es impostergable.

OBJECTIVE. To document the status of operational and managerial processes of the Fund for Protection against Catastrophic Expenses (FPGC), as well as to describe its evolution, and to explore the relationship between covered diseases and the Mexican health profile. MATERIAL AND METHODS. This is a joint management study, which included a qualitative and a quantitative phase. We conducted semi-structured interviews with key informants. We also analyzed the records of CNPSS, the hospital discharge and mortality data bases. RESULTS. Fifty two percent of the states take twice as long to report and validate the cases. From 2004-2009 the FPGC increased its coverage from 6 to 49 interventions, that means a spending increase of 2 306.4 percent in nominal terms and 1 659.3 percent in real terms. The HIV/AIDS was the intervention prioritized with 39.3 percent and Mexico City had the highest proportion of expenditure (25.1 percent). A few diseases included in the health profile are covered by the FPGC. CONCLUSIONS. The review of the inclusion criteria of diseases is urgent, so as to cover diseases of epidemiological importance.

Separación de funciones en el Sistema de Protección Social en Salud, México 2009: avances y retos / Separation of functions in the System of Social Protection in Health, Mexico 2009: progress and challenges

OBJETIVO. Analizar los avances y retos de la separación de funciones en el Sistema de Protección Social en Salud en México. MATERIAL Y MÉTODOS. Investigación evaluativa realizada en 2009. Se incorporaron nueve entidades federativas y la Comisión Nacional de Protección Social en Salud. Se realizaron entrevistas semiestructuradas a informantes clave y análisis documental. RESULTADOS. El principal avance es la creación de los Regímenes Estatales de Protección Social en Salud (REPSS), con una función de intermediación entre los usuarios y los prestadores de servicios de salud. Éstos se constituyen como instancias del nivel estatal encargadas de administrar los recursos financieros y conformar y coordinar la red de prestación de servicios de atención médica. No obstante, la mayoría de los REPSS estudiados se encuentran en un estado de inercia que les impide cumplir adecuadamente con las funciones marcadas por la ley. CONCLUSIÓN. Persisten obstáculos normativos, técnicos, políticos y gerenciales para cumplir con la separación de funciones.

OBJECTIVE. To evaluate advancements and challenges in the separation of functions within Mexico's System of Social Protection in Health. MATERIAL AND METHODS. A 2009 evaluation study involving nine states and the National Commission for Social Protection in Health was carried out via semi-structured interviews with key actors and literature analysis. RESULTS. The main advancement has been the creation of the State Regimens for Social Protection in Health (REPSS in Spanish) which act as intermediaries between users and health service providers, making these state-level entities responsible for both managing financial resources and shaping and coordinating the health care delivery network. However, most of the REPSS studied were found to be in a state of inertia, leading to inadequate compliance with legally mandated functions. CONCLUSION. Normative, technical, political and managerial obstacles persist, impeding the successful separation of functions.

Acciones gubernamentales para la detección temprana del cáncer de mama en América Latina: Retos a futuro / Government actions for the early detection of breast cancer in Latin America: Future challenges

Se presenta investigación documental realizada en 2009 que pretende documentar el marco normativo y los programas vigentes para la detección temprana del cáncer mamario en América Latina y establecer los retos más importantes para contener la epidemia en la región. Se identificaron diversas iniciativas emprendidas por las autoridades gubernamentales de salud para contrarrestar el crecimiento de la morbi-mortalidad por esta causa mediante estrategias de detección temprana, atención e investigación. A pesar de los avances en el diseño de políticas, programas, protocolos y guías de manejo clínico, persisten importantes retos para lograr los objetivos propuestos y la contención de este problema.

Documentary research carried out in 2009 aims to document the regulatory framework and existing programs for the early detection of breast cancer in Latin America and the Caribbean in order to establish the most important challenges for the containment of the epidemic in the region. The governments of the region have developed diverse efforts and initiatives to confront the rise in mortality due to said cause, including early detection, treatment and research strategies. Despite advances in the early detection of breast cancer, the challenge remains to link efforts to ensure continuity of care (diagnostic confirmation, treatment and monitoring) in order to achieve higher efficiency, effectiveness and benefits for women with this disease.

[Government actions for the early detection of breast cancer in Latin America. Future challenges]. / Acciones gubernamentales para la detección temprana del cáncer de mama en América Latina. Retos a futuro.

Documentary research carried out in 2009 aims to document the regulatory framework and existing programs for the early detection of breast cancer in Latin America and the Caribbean in order to establish the most important challenges for the containment of the epidemic in the region. The governments of the region have developed diverse efforts and initiatives to confront the rise in mortality due to said cause, including early detection, treatment and research strategies. Despite advances in the early detection of breast cancer, the challenge remains to link efforts to ensure continuity of care (diagnostic confirmation, treatment and monitoring) in order to achieve higher efficiency, effectiveness and benefits for women with this disease.

Formación, empleo y regulación de los recursos humanos para la salud: bases para su planeación estratégica / Training, employment and regulation of human resources for health: bases for strategic planning

Este libro deberá servir como referencia para los tomadores de decisiones comprometidos con la mejora en el acceso y la calidad de los servicios de salud para que éstos respondan a las necesidades de los mexicanos y les garanticen que su atención estará en manos de trabajadores de la salud debidamente formados y motivados. los problemas que los autores abordan en las páginas de esta obra no son nuevos ni exclusivos de méxico. la mayoría de los países, incluso los más ricos, enfrentan graves dificultades por la distribución desigual de recursos humanos entre los diferentes tipos de servicios (demasiados en los hospitales, muy pocos en las comunidades), las profesiones (escasas enfermeras en relación con el número de médicos) y las zonas geográficas. otros problemas típicos son la falta de reciprocidad entre la formación y las necesidades reales que enfrentan los profesionales cuando se insertan en el sector salud, la incipiente planificación en la dotación de recursos humanos y la deficiente regulación en relación con la calidad del entrenamiento y la práctica clínica. estos inconvenientes han afectado al sector salud durante décadas; sin embargo, como señalan los autores de los textos que aquí se presentan, ha sido apenas en los últimos años cuando los tomadores de decisiones en los ámbitos tanto nacional como internacional han prestado atención a los recursos humanos.(AU)

Errores o equivocaciones por acción u omisión en acciones de promoción y prevención dirigidas a gestantes en Manizales, 2007 / Erros ou equivocos por ação ou omissão em ações de promoção dirigida a gestantes em Manizales, 2007 / Errors and mistakes due to action or omission in promotional and preventional actions directed to pregnant mothers in Manizales, 2007

El propósito del presente trabajo es mostrar los resultados de la investigación sobre errores y equivocaciones por acción u omisión en acciones de promoción y prevención dirigidas a gestantes en Manizales realizada durante el año 2007. El estudio realizado fue de tipo descriptivo retrospectivo y evaluativo. Éste se llevó a cabo con usuarios de los programas de promoción y prevención y profesionales responsables de dicho programa; la muestra de los usuarios a encuestar se determinó mediante un muestreo aleatorio simple con una confianza del 95% y un error del 5%, y la de los profesionales se realizó a conveniencia tendiendo en cuenta quiénes realizaban los controles o consultas. Se aplicó una entrevista individual. Se analizó en Epiinfo 2002 y SPSS. Entre los resultados, queremos mencionar que los errores y equivocaciones más frecuentes por parte de los usuarios fueron inasistencia a actividades propias del programa, automedicación y escaso cumplimiento de recomendaciones de autocuidado; entre los errores y equivocaciones por parte de los profesionales se resaltan falta de interrogatorio, no seguimiento a inasistentes, escasas explicaciones durante el control o la consulta y omisión de exámenes paraclínicos; también se identificaron errores en el sistema relacionados con falta de oportunidad en la entrega de medicamentos y en la asignación de citas

The purpose of this paper is to show the research results on the errors and mistakes due to action or omission in promotion and prevention aimed at pregnant mothers in Manizales in 2007. It was a retrospective, descriptive and evaluative study, that was carried out with users of promotion and prevention programs, and the responsible professionals of these programs. The sample of users was determined with a random sample, with a confidence margin of 95% and a margin error of 5%. The sample of the professionals was conducted in concordance with the people who were in charge of the check-ups or consultations. Individual interviews were carried out, with the data being analyzed with Epiinfo 2002 and SPSS. Among the results, we would like to mention that the most frequent errors and mistakes by users had been the absence in program activities, self-medication and not thoroughly following medical indications. The most relevant professional mistakes include few questions regarding the patients’ clinical history; not following-up on absent patients; few explanations on the importance of controls, and omission of paraclinical exams. Errors in the system regarding convenient medicine delivery and in the assignment of medical appointments were also identified

O propósito da presente pesquisa é apresentar os resultados da averiguação sobre erros e equivocos por ação ou omissão em ações de promoção e prevenção dirigidas a gestantes em Manizales feitas durante o ano 2007. A pesquisa realizada foi de tipo descritivo retrospectivo e de avaliação. A pesquisa foi realizada com usuários dos programas de promoção e prevenção e profissionais responsáveis de programa, a amostra de usuários a serem visitadas foi determinada por uma amostra aleatória simples com uma confiança de 95% e 5% de erro, e profissionais foi realizada por conveniência tendo em conta que realizou as inspeções ou consultas. Aplicamos uma única entrevista. Foram analisados no EpiInfo 2002 e SPSS. Entre os resultados, podemos dizer que os erros mais comuns e erros por parte dos usuários eram não-comparecimento às atividades do programa, a auto-medicação e má aderência com recomendações de auto-atendimento, entre os erros e os erros por falta de interrogatório destaques profissionais, no seguimento aos faltosos explicação, insuficiente para a supervisão ou consulta e falta de exames laboratoriais; erros do sistema identificou também relacionadas com a falta de pontualidade na entrega de medicamentos e agendamento.

Acceso al programa de hipertensión en el Sistema General de Seguridad Social en Salud, 2008 / Acesso ao programa de hipertensão no sistema geral de seguridade social em saúde, 2008 / Access to the hypertension program in the general social welfare health system, 2008

Con esta investigación se evaluó el acceso de los usuarios con hipertensión arterial a las actividades de promoción y prevención del programa, para lo cual se realizó un estudio evaluativo, con una entrevista aplicada a una muestra de 403 hipertensos seleccionados aleatoriamente de las bases de datos de tres Empresas Promotoras de Salud (EPS), cuatro Empresas Promotoras de Salud del Régimen Subsidiado (EPSS) y la Secretaría de Salud, y a responsables de programas y profesionales de estas instituciones. Se realizó análisis univariado y multivariado que permitió la conformación de tres tipologías de pacientes. Se encontró que en Manizales los hipertensos se caracterizan por tener una edad promedio de 69,7 años, y ser el 55,6% del sexo masculino. El acceso al programa de hipertensión se caracteriza porque se tiene implementado el programa acorde con la guía con algunas diferencias entre instituciones, como existencia de clubes y estrategias de educación. Los hipertensos tienen garantizado el acceso potencial, evidenciándose una falencia en el suministro de medicamentos y en la oportunidad de la cita con el especialista, los pacientes asisten de manera oportuna a los controles, sin embargo la integralidad del programa se ve afectada por la inasistencia de la mayoría de éstos a las actividades grupales justificadas en razones como la oferta del programa, falta de tiempo y recursos económicos. La mayoría de los usuarios se encuentran satisfechos con la atención que reciben en los controles.

This paper presents the results of a research to evaluate the access of hypertensive users to the activities of the Promotion and Prevention Programs. This evaluative study was carried out through interviews applied to a population of 403 hypertensive patients selected at random out of three Health Promotion Entities (EPS by its initials in Spanish), four Institutions of Social Protection Health Promotion Centers (EPSS), the Health Secretary, and the people responsible for the programs and professionals from these institutions. Univariated and multivariate analyses were carried out, in order to construct three sets of patients. In Manizales, hypertensive patients have an average age of 69.7 years and 55.6% are male. Access to the hypertension program was characterized by the fact that the program is based on the norm, with some differences among institutions, such as the existence of clubs and educational strategies. Potential access to hypertensive patients is guaranteed, but the provision of medications and the opportunity to have appointments with specialists were found to be deficient. Hypertensive patients attend their individual check-ups, but their absence in group activities affects the integrality of the program. They justify their absence with lack of offers of the program, lack of time, and economic problems. Most users find the control session attention satisfactory.

Com esta pesquisa se avaliou o acesso dos usuários com hipertensão arterial às atividades de promoção e prevenção do programa, para o qual se realizou uma pesquisa evaluativo, com uma entrevista aplicada a uma amostra de 403 hipertensos selecionados aleatoriamente das bases de dados de três Empresas Promotoras de Saúde (EPS), quatro Empresas Promotoras de Saúde do Regime Subsidiado (EPSS) e a Secretaria de Saúde, e responsáveis de programas e profissionais destas instituições. Realizou-se análise uni-variado e multivariado que permitiu a conformação de três tipologias de pacientes. Encontrou-se que em Manizales os hipertensos se caracterizam por ter uma idade média de 69,7 anos, e ser o 55,6% do sexo masculino. O acesso ao programa de hipertensão se caracteriza por que se tem implementado o programa acorde com a guia com algumas diferenças entre instituições, como existência de clubes e estratégias de educação. Os hipertensos têm garantido o acesso potencial, evidenciando se uma falência no subministro de medicamentos e na oportunidade do encontro com o especialista, os pacientes assistem de maneira oportuna aos controles, sem embargo a integralidade do programa se vê afetado por a não assistência da maioria destes às atividades grupais justificadas em razões como a oferta do programa, falta de tempo e recursos econômicos. As maiorias dos usuários se encontram satisfeitos com a atenção que recebem nos controles.