ABSTRACT
The global burden of cervical cancer remains a concern and higher early mortality rates are associated with poverty and limited health education. However, screening programs continue to face implementation challenges, especially in developing country contexts. In this study, we use a mixed-methods approach to understand the reasons for no-show behaviour for cervical cancer screening appointments among hard-to-reach low-income women in Bogotá, Colombia. In the quantitative phase, individual attendance probabilities are predicted using administrative records from an outreach program (N = 23384) using both LASSO regression and Random Forest methods. In the qualitative phase, semi-structured interviews are analysed to understand patient perspectives (N = 60). Both inductive and deductive coding are used to identify first-order categories and content analysis is facilitated using the Framework method. Quantitative analysis shows that younger patients and those living in zones of poverty are more likely to miss their appointments. Likewise, appointments scheduled on Saturdays, during the school vacation periods or with lead times longer than 10 days have higher no-show risk. Qualitative data shows that patients find it hard to navigate the service delivery process, face barriers accessing the health system and hold negative beliefs about cervical cytology.
Subject(s)
Early Detection of Cancer , Uterine Cervical Neoplasms , Appointments and Schedules , Colombia , Early Detection of Cancer/methods , Female , Humans , Mass Screening , Qualitative Research , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/prevention & control , Vaginal SmearsABSTRACT
Resumen Objetivo: Describir el perfil epidemiológico de los pacientes remitidos al servicio de hospitalización domiciliaria por una institución de tercer nivel en el Valle de Aburrá, en 2015. Metodología: Estudio descriptivo transversal de los pacientes atendidos (n = 4956 pacientes y 109 032 registros). La fuente de información corresponde a la base de datos del servicio de atención domiciliaria durante el año 2015 de una institución de nivel tres en el Valle de Aburrá. Se determinó la distribución por edad, sexo, tipo de patología, ubicación espacial y tipo de manejo del tratamiento. Resultados: El servicio se prestó en su mayoría a mujeres (55 %) cuya edad oscilaba entre los 50 y 90 años. Los pacientes provenían principalmente de los estratos 1, 2 y 3, pertenecientes al régimen contributivo. Las cuatro principales patologías son: enfermedades de la piel y el tejido subcutáneo (cie-10 L00-L99, 32 %) asociadas con el manejo de heridas quirúrgicas, enfermedades del aparato genitourinario (cie-10 N00-N99, 21 %), enfermedades respiratorias (cie-10 J00-J99, 18 %) y las enfermedades infecciosas y parasitarias (cie-10 A00-B99, 7 %). Conclusiones: La hospitalización domiciliaria en el Valle de Aburrá se orienta hacia el cuidado del adulto mayor, en especial a mujeres mayores de 50 años, para las cuales, en su mayoría, su plan de manejo es mediante el suministro de antibióticos.
Abstract Objective: To describe the epidemiological profile of patients referred to the home hospitalization service by a level 3 institution in the Aburrá Valley, in 2015. Methodology: Cross-sectional descriptive study of treated patients (n = 4956 patients and 109 032 records). The source of information corresponds to the 2015 database of the home care service of a level 3 institution in the Aburrá Valley. Distribution was determined by age, sex, type of pathology, spatial location and type of treatment management. Results: The service was provided mostly to women (55%) with ages between 50 and 90 years. Patients came mainly from socioeconomic strata 1, 2 and 3, belonging to the contributory regime. The four main pathologies are: skin and subcutaneous tissue diseases (CIE-10 L00-L99, 32%) associated with management of surgical wounds, genitourinary system diseases (CIE-10 N00-N99, 21%), respiratory diseases (CIE-10 J00-J99, 18%) and infectious and parasitic diseases (CIE-10 A00-B99, 7%). Conclusions: Home hospitalization in the Aburrá Valley focuses in the care of the elderly, especially women over 50, whose management plan involves the supply of antibiotics in the majority of cases.
Resumo Objetivo: Descrever o perfil epidemiológico dos pacientes encaminhados para serviços de assistência domiciliar por uma instituição de nível três no Valle de Aburrá em 2015. Metodologia: Estudo transversal de pacientes tratados (n = 4956 pacientes e 10,032 registros). A fonte de informação corresponde ao banco de dados do serviço de assistência domiciliar durante o ano de 2015 de uma instituição de nível três no Valle de Aburrá. A distribuição foi determinada por idade, sexo, tipo de patologia, localização espacial e tipo de tratamento. Resultados: O serviço foi prestado principalmente para mulheres (55%) cuja idade variou entre 50 e 90 anos. Os pacientes vieram principalmente dos estratos 1, 2 e 3, pertencentes ao regime contributivo. As quatro principais patologias são doenças da pele e do tecido subcutâneo (ICD- 10 L00-L99, 32%) associada com o tratamento de feridas cirúrgicas, doenças do trato geniturinário (ICD-10 N00-N99, 21%), Doenças respiratórias (CID-10 J00-J99, 18%) e doenças infecciosas e parasitárias (CID-10 A00-B99, 7%). Conclusões: A internação domiciliar no Valle de Aburrá é voltada para o cuidado do idoso, principalmente de mulheres com mais de 50 anos, para quem, em sua maioria, o plano de manejo é por meio do fornecimento de antibióticos.
