Dos Santos Andrade Lorena Sofia, De Melo Santos Tácila Thamires, Case de Oliveira Milena Edite, Lima Gomes Kedma Anne, Araújo Pereira Soares Adriana Raquel, Almeida de Oliveira Tiago, Weller Mathias
Post Graduate Program in Public Health, State University of Paraíba (UEPB), Campina Grande-Paraíba.
Department of Statistics, State University of Paraíba (UEPB), Campina Grande-Paraíba.
J Public Health Res. 2021 Mar 10;10(3):1880. doi: 10.4081/jphr.2021.1880.
The diagnosis of breast cancer requires a complicated series of diagnostic exams. The present study addressed the delay of patients who used publicly and privately financed diagnostic services. Non-governmental organizations (NGOs) donated diagnostic mammograms and biopsies.
Data from 304 patients were obtained from two Brazilian referral centres. In one referral centre (FAP), diagnostic mammography, clinic-histopathological exam and immunohistochemistry were outsourced, whereas in the other centre (HNL), these services were integrated. Cox regression, Kaplan-Meier analysis and non-parametric tests were used to compare variables and time intervals.
If diagnostic mammography was financed privately and covered by private health insurance, the likelihood of a delay of >90 days between the first medical visit and the initiation of treatment decreased 2.15-fold (95%CI: 1.06- 4.36; p=0.033) and 4.44-fold (95%CI: 1.58-12.46; p=0.004), respectively. If the clinic-histopathological exam was outsourced (FAP) and publicly or privately financed, the median time between diagnostic mammography and the diagnostic result was 53 and 65 days in the integrated (HNL) and outsourced public system, compared to 29 days in the outsourced private system (p<0.050). The median time between the first medical visit and the diagnostic results of patients who were supported by NGOs, who financed their diagnostic services privately, and who used exclusively public diagnostic services was, respectively, 28.0, 48.5 and 77.5 days (p<0.050).
Patients who used privately financed health services had shorter delays. Compared to outsourcing, the integration of the publicly financed clinic- histopathological exam diminished the delay. The support of patients by NGOs accelerated patient flow.
乳腺癌的诊断需要一系列复杂的诊断检查。本研究探讨了使用公共和私人资助诊断服务的患者的诊断延迟情况。非政府组织（NGO）捐赠了诊断性乳房X光检查和活检服务。
从巴西的两个转诊中心获取了304例患者的数据。在一个转诊中心（FAP），诊断性乳房X光检查、临床组织病理学检查和免疫组织化学检查是外包的，而在另一个中心（HNL），这些服务是整合的。使用Cox回归、Kaplan-Meier分析和非参数检验来比较变量和时间间隔。
如果诊断性乳房X光检查由私人资助并由私人健康保险覆盖，首次就诊与开始治疗之间延迟超过90天的可能性分别降低了2.15倍（95%CI：1.06 - 4.36；p = 0.033）和4.44倍（95%CI：1.58 - 12.46；p = 0.004）。如果临床组织病理学检查是外包的（FAP）且由公共或私人资助，在整合的（HNL）和外包的公共系统中，从诊断性乳房X光检查到诊断结果的中位时间分别为53天和65天，而在外包的私人系统中为29天（p < 0.050）。由NGO支持、私人资助诊断服务以及仅使用公共诊断服务的患者，从首次就诊到诊断结果的中位时间分别为28.0天、48.5天和77.5天（p < 0.050）。
使用私人资助医疗服务的患者诊断延迟较短。与外包相比，公共资助的临床组织病理学检查的整合减少了延迟。NGO对患者的支持加快了患者流程。
