RESUMO
Objetivos: Evaluar los intervalos de diagnóstico (ID) y tratamiento (IT) de los cánceres más prevalentes en pacientes adscritos a 2 centros de salud, y analizar la influencia de factores sociodemográficos, clínicos y de organización del sistema sanitario (SS).DiseñoEstudio observacional de cohortes, retrospectivo y analítico.LocalizaciónAtención primaria. Dos centros de salud urbanos.ParticipantesTrescientos sesenta y cinco pacientes diagnosticados de cáncer colorrectal (CCR), mama, pulmón, próstata o vejiga entre el 1/1/2012 y el 31/12/2017.Medidas principalesSe comparan las medianas de ID e IT y el riesgo (OR) de ID e IT superiores a esas medianas según los factores mencionados. Se analiza la contribución de cada etapa del proceso al ID.ResultadosLa mediana del ID fue 92 días, máxima en cáncer de próstata (395 días) y mínima en pulmón (54 días). Factores relacionados con ID prolongado (OR>92 días) fueron sexo femenino, localización CCR o prostática, estadío localizado, consulta índice en atención primaria (AP) y ruta diagnóstica ambulatoria. Un IT prolongado (OR>56 días) se relacionó con la localización de CCR o prostática y ruta diagnóstica ambulatoria. Componentes del ID con mayor influencia en la demora fueron: intervalo de atención primaria (IAP), demora de atención secundaria (DAS) y demora de la prueba complementaria de atención secundaria (DPCAS). La contribución del IAP fue mayor en pacientes con CCR, pulmón y vejiga.ConclusionesLos ID e IT fueron 92 y 56 días, respectivamente. Los componentes del ID con mayor contribución a la demora fueron IAP, DAS y DPCAS. Aumentar la capacidad diagnóstica en AP y organizar itinerarios específicos de diagnóstico y tratamiento, acortaría dichos intervalos y permitiría una detección más temprana.
Objectives: To assess the diagnostic (ID) and treatment (IT) intervals of the most prevalent cancers in patients attached to two health centres and to analyse the influence of sociodemographic, clinical and health system (HS) organisational factors.DesignObservational, retrospective, analytical cohort study.SitePrimary care. Two urban health centres.ParticipantsThree hundred sixty-five patients diagnosed with colorectal cancer (CRC), breast, lung, prostate or bladder cancer between 1/1/2012 and 31/12/2017.Main measuresThe medians of ID and IT and the risk (OR) of ID and IT above those medians according to the above factors are compared. The contribution of each process step to ID is analysed.ResultsMedian ID was 92 days, maximum in prostate cancer (395 days) and minimum in lung (54 days). Factors associated with prolonged ID (OR>92 days) were female sex, CRC or prostate location, localised stage, index primary care (AP) consultation and outpatient diagnostic pathway. Prolonged IT (OR>56 days) was related to CRC or prostate location and outpatient diagnostic route. ID components with the greatest influence on delay were: Primary Care Interval (IAP), Secondary Care Delay (DAS) and Secondary Care Adjunctive Test Delay (DPAS). The contribution of IAP was highest in patients with CRC, lung and bladder.ConclusionsID and IT were 92 and 56 days respectively. The ID components with the highest contribution to delay were IAP, DAS and DPAS. Increasing diagnostic capacity in PC and organising specific diagnostic and treatment pathways would shorten these intervals and allow earlier detection.
Assuntos
Humanos , Masculino , Ciências da Saúde , Atenção Primária à Saúde , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/terapia , Estudos de Coortes , Neoplasias da Mama , Neoplasias Pulmonares , Neoplasias da PróstataRESUMO
OBJECTIVES: To assess the diagnostic (ID) and treatment (IT) intervals of the most prevalent cancers in patients attached to two health centres and to analyse the influence of sociodemographic, clinical and health system (HS) organisational factors. DESIGN: Observational, retrospective, analytical cohort study. SITE: Primary care. Two urban health centres. PARTICIPANTS: Three hundred sixty-five patients diagnosed with colorectal cancer (CRC), breast, lung, prostate or bladder cancer between 1/1/2012 and 31/12/2017. MAIN MEASURES: The medians of ID and IT and the risk (OR) of ID and IT above those medians according to the above factors are compared. The contribution of each process step to ID is analysed. RESULTS: Median ID was 92 days, maximum in prostate cancer (395 days) and minimum in lung (54 days). Factors associated with prolonged ID (OR>92 days) were female sex, CRC or prostate location, localised stage, index primary care (AP) consultation and outpatient diagnostic pathway. Prolonged IT (OR>56 days) was related to CRC or prostate location and outpatient diagnostic route. ID components with the greatest influence on delay were: Primary Care Interval (IAP), Secondary Care Delay (DAS) and Secondary Care Adjunctive Test Delay (DPAS). The contribution of IAP was highest in patients with CRC, lung and bladder. CONCLUSIONS: ID and IT were 92 and 56 days respectively. The ID components with the highest contribution to delay were IAP, DAS and DPAS. Increasing diagnostic capacity in PC and organising specific diagnostic and treatment pathways would shorten these intervals and allow earlier detection.