Motivos de abandono en el proceso de atención médica de lesiones precursoras de cáncer cervicouterino / Medical care abandon factors in precursor lesions of cervical cancer

ABSTRACT

Objective. To determine factors associated with medical care abandon of women with CIN. Material and methods. A nested case-control study in a cohort was done. Patients referred to clinical Dysplasia of Gyneco-Obstetrician Services in third level Hospitals were considered. Cases: Patients who abandoned medical care. Controls: women who attend their medical appointments during follow-up. All subjects underwent structured interviews focused on social, clinical and health services factors in two different times, applied at the beginning of study and the end of follow-up. Clinical records were reviewed to obtain clinical information. Analysis: Descriptive and inferential statistical was done. Non conditional Logistic Regression analysis was done to obtain adjusted association. Results. Abandon cumulative incidence rate was 108/525 = 20.7% (I.C 95% = 17.2-24.3); 60.2% happened in diagnosis phase, 17.7% ocured during therapeutic phase and 23.1% happened in surveillance phase. We studied 108 cases and 417 controls to analysis. Next adjusted risk factors were obtained: Afraid to death (ORa = 4.2, I.C.95% = 1.8-9.5), long appointments (ORa = 6.6, I.C95% = 3.4-13.0), lack of privacity (ORa = 12.5, I.C.95% = 2.6-59.8), reject to treatment (ORa = 40.4, I.C.95% = 2.1-785.4), lack of information (ORa = 41.9, I.C95% =14.2-124.1) and other factors. Conclusions. Patient perception, access and barriers in health services were the most important factors associated with medical care abandon.

RESUMEN

Objetivo. Determinar factores asociados al abandono del proceso de atención de NIC. Material y métodos. Se realizó un estudio de casos y controles anidado en una cohorte de mujeres referidas a las clínicas de displasias de dos hospitales de tercer nivel. Casos: pacientes que abandonaron su atención médica. Controles: pacientes que cumplieron con sus citas médicas. Las pacientes contestaron una entrevista estructurada respecto a variables sociodemográficas y de atención médica al inicio y al final del seguimiento. Los datos clínicos se obtuvieron de la revisión de expedientes. Análisis: Medidas de frecuencia y asociación, ajustando variables con Regresión Logística no Condicionada. Resultados. La tasa de abandono fue de 108/525 = 20.7% (17.2-24.3); 60.2% ocurrieron en la fase diagnóstica, 17.7% durante el tratamiento y 23.1% en la fase de vigilancia y/o control. Un total de 108 casos y 417 controles fueron considerados para el análisis. Los factores de riesgo ajustados fueron: miedo a la muerte (ORa = 4.2, I.C.95% = 1.8-9.5), citas prolongadas (ORa = 6.6, I.C.95% = 3.4-13.0), falta de privacidad (ORa = 12.5, I.C.95% = 2.6-59.8), rechazo al tratamiento propuesto (ORa = 40.4, I.C.95% = 2.1-785.4) y falta de información (ORa = 41.9, I.C.95% = 14.2-124.1) entre otros. Conclusiones. Los factores relacionados con la percepción de gravedad de la enfermedad y las barreras al acceso de los servicios de salud fueron los de mayor importancia para abandonar la atención médica.