Vargas Ingrid, Mogollón-Pérez Amparo-Susana, Eguiguren Pamela, Torres Ana-Lucía, Peralta Andrés, Rubio-Valera Maria, Jervelund Signe Smith, Borras Josep M, Dias Sónia, Vázquez María-Luisa
Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avinguda Tibidabo, 21, 08022, Barcelona, Spain.
Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Carrera 24 No. 63 C-69. Quinta Mutis, Bogotá, Colombia.
Soc Sci Med. 2025 Jan;365:117499. doi: 10.1016/j.socscimed.2024.117499. Epub 2024 Nov 15.
Although the greatest delays in cancer diagnosis in Latin America occur in the provider interval little is known about the related factors. This study aims to analyze factors influencing access to cancer diagnosis -from initial contact with health services to confirmation- from institutional stakeholders' perspective in public healthcare networks of Chile, Colombia, and Ecuador. A qualitative, descriptive-interpretative study was conducted in two networks per country, using semi-structured individual interviews (n = 118; 23 to 58, per country) with a criterion sample of health professionals and administrative personnel from primary care (PC) (n = 41) and secondary/tertiary care hospitals (n = 47), network managers and policymakers (n = 30). The final sample size was reached through saturation. Thematic content analysis was performed, segmented by country. The analysis reveals interacting factors that cause cumulative delays throughout the patient's diagnostic pathway within healthcare networks, with differences between countries. In all three, informants identify similar characteristics of the networks: structural (deficits in diagnostic resources; geographical accessibility), organizational factors (long waiting times, especially after referral), and the limited knowledge and experience of PC doctors, which all lead to delayed diagnosis. In Chile and Colombia, health policy barriers related to care rationing/prioritization policies that hampered access to tests, and in Chile, increased delays for non-prioritized conditions. Country-specific barriers related to the organization of healthcare system also emerge: in Chile, private services subcontracting and the voucher system for using them; in Colombia, the management of care by insurers (care authorizations; fragmented and short-term contracting of providers); and in Ecuador, underfunding of the system. The barriers most affect the elderly, those with low socioeconomic status, with limited support networks, and rural areas residents. The results reveal relevant barriers in access to timely cancer diagnosis which can and should be addressed with specific cancer diagnosis policies and general measures that strengthen public healthcare systems and networks.
尽管拉丁美洲癌症诊断的最大延误发生在医疗服务提供间隔期，但对相关因素却知之甚少。本研究旨在从智利、哥伦比亚和厄瓜多尔公共医疗网络中机构利益相关者的角度，分析影响癌症诊断可及性的因素——从首次接触医疗服务到确诊。在每个国家的两个网络中开展了一项定性的描述性解释性研究，对来自初级保健（PC）（n = 41）和二级/三级护理医院（n = 47）的卫生专业人员和行政人员、网络管理人员和政策制定者（n = 30）进行了半结构化个人访谈（每个国家23至58人；共n = 118）。通过饱和度达到最终样本量。进行了主题内容分析，并按国家进行了细分。分析揭示了在医疗网络中导致患者诊断路径出现累积延误的相互作用因素，各国之间存在差异。在所有三个国家中，受访者都指出了网络的相似特征：结构因素（诊断资源不足；地理可及性）、组织因素（等待时间长，尤其是转诊后）以及初级保健医生知识和经验有限，所有这些都导致诊断延迟。在智利和哥伦比亚，与医疗配给/优先排序政策相关的卫生政策障碍阻碍了检测的可及性，在智利，非优先疾病的延误增加。还出现了与医疗系统组织相关的特定国家障碍：在智利，私人服务分包以及使用这些服务的代金券系统；在哥伦比亚，保险公司的医疗管理（医疗授权；提供者的分散和短期合同）；在厄瓜多尔，系统资金不足。这些障碍对老年人、社会经济地位低、支持网络有限的人群以及农村地区居民影响最大。结果揭示了及时获得癌症诊断方面的相关障碍，这些障碍可以而且应该通过具体的癌症诊断政策以及加强公共医疗系统和网络的一般措施来解决。
