Puschel K, Rioseco A, Soto M, Paz S, Martinez J, Soto G, Faundez M, Arenas E, Vescovi Z, Fuentes I, Thompson B, Emery J
Department of Family and Community Medicine, School of Medicine, Universidad Católica de Chile, Chile; Center for Cancer Prevention and Control (CECAN), Chile.
Department of Family and Community Medicine, School of Medicine, Universidad Católica de Chile, Chile; Center for Cancer Prevention and Control (CECAN), Chile.
Public Health. 2024 Nov;236:168-174. doi: 10.1016/j.puhe.2024.08.006. Epub 2024 Sep 7.
The burden of cancer is increasing rapidly in Latin America. Primary care has an essential role in cancer prevention, but implementation levels of prevention practices are not well known. This study evaluated implementation levels and associated factors of cancer preventive practices in primary care over time.
The study incorporated a retrospective multicentre cohort study.
A population of 59,949 patients registered at three primary care clinics was followed from January 2018 to December 2022 in Santiago, Chile. We studied human papillomavirus (HPV) and hepatitis B virus (HBV) immunisation, brief counselling for smoking cessation and alcohol consumption, and cervical and breast cancer screening practices. Standardised electronic medical records were utilised as the source of information. Social, clinical, and organisational factors associated with prevention practices were studied.
The cohort attrition level was 17.1%. Most of the population was of a low socioeconomic status, and 70% visited a primary health centre yearly. Implementation rates of immunisation practices were 90.84% for HPV and 80.94% for HBV in 2022. In contrast, brief counselling for smoking and alcohol consumption was below 20% during the study period. Cervical cancer screening decreased by 25.58% between 2018 and 2022, whereas breast cancer screening reached only 41.71% of the target population. Opportunistic medical visits were strongly associated with brief counselling and breast cancer screening.
Implementation practices for cancer prevention in a Chilean primary care cohort are high for immunisation and very low for brief counselling and screening practices. A comprehensive non-medical-based model is needed to improve cancer prevention in primary care.
拉丁美洲的癌症负担正在迅速增加。初级保健在癌症预防中起着至关重要的作用，但预防措施的实施水平尚不清楚。本研究评估了初级保健中癌症预防措施随时间的实施水平及相关因素。
该研究纳入了一项回顾性多中心队列研究。
2018年1月至2022年12月期间，对智利圣地亚哥三家初级保健诊所登记的59949名患者进行了随访。我们研究了人乳头瘤病毒（HPV）和乙肝病毒（HBV）免疫接种、戒烟和减少饮酒的简短咨询以及宫颈癌和乳腺癌筛查措施。使用标准化电子病历作为信息来源。研究了与预防措施相关的社会、临床和组织因素。
队列损耗率为17.1%。大多数人群社会经济地位较低，70%的人每年访问一次初级保健中心。2022年HPV免疫接种率为90.84%，HBV免疫接种率为80.94%。相比之下，在研究期间，关于吸烟和饮酒的简短咨询低于20%。2018年至2022年期间，宫颈癌筛查率下降了25.58%，而乳腺癌筛查仅覆盖了目标人群的41.71%。机会性就诊与简短咨询和乳腺癌筛查密切相关。
智利初级保健队列中的癌症预防实施措施在免疫接种方面较高，而在简短咨询和筛查方面非常低。需要一个全面的非医学模式来改善初级保健中的癌症预防。
