ABSTRACT
OBJECTIVE: To obtain breast cancer survival estimates in Manizales, Colombia, considering socioeconomic level, health insurance regime and residential area, while adjusting for age, histology and stage at diagnosis. METHODS: Analytical cohort study based on breast cancer incident cases recorded by the Population-based Manizales Cancer Registry between 2008-2015. Patients were followed-up for 60 months. Cause-specific survival was calculated using the Kaplan-Meier method for variables of interest, with the Wilcoxon-Breslow-Gehan test for differences. Cox multivariate regression models were fitted. RESULTS: 856 breast cancer cases were included. The 5-year cause-specific survival for the entire cohort was 78.2%. It was higher in women with special/exception health insurance, high socioeconomic level, <50 years old, ductal carcinoma, and stages I and II. Residential area did not impact survival. In Cox models, the subsidized health insurance regime (HR: 4.87 vs contributory) and low socioeconomic level (HR: 2.45 vs high) were predictors of the hazard of death in women with breast cancer, adjusted for age, histology, stage and interactions age-stage and insurance-stage. A positive interaction (synergistic effect modification) between health insurance regime and stage regarding to survival was observed. CONCLUSION: Socioeconomic factors significantly contribute to the inequities in breast cancer survival, independent of the stage at diagnosis. This suggests the need for comprehensive interventions to remove barriers to accessing the health system. This research provides evidence of survival gaps mediated by certain social determinants of health and generates data on the overall performance of the Colombian health system.
Subject(s)
Breast Neoplasms , Humans , Female , Middle Aged , Breast Neoplasms/epidemiology , Breast Neoplasms/therapy , Breast Neoplasms/diagnosis , Colombia/epidemiology , Cohort Studies , Breast , Health InequitiesABSTRACT
Resumen Introducción: Las percepciones de los usuarios frente a los servicios de salud son indicadores indispensables de calidad sobre procesos de atención sanitaria. Objetivo: Conocer las percepciones de los usuarios de una red pública del municipio de Pasto, Colombia frente a la calidad de los servicios de salud del primer nivel de atención. Materiales y métodos: Investigación cualitativa con enfoque histórico hermenéutico con 28 participantes, usuarios de centros de atención rurales y urbanos. Las técnicas de recolección de información desarrolladas fueron entrevistas semiestructuradas y un grupo focal. El proceso investigativo abordó las dimensiones: confianza, fiabilidad, responsabilidad, capacidad de respuesta y tangibilidad. Resultados: En las dimensiones se identificaron como limitantes en la calidad, dificultades de acceso por aspectos administrativos y geográficos, problemas en la oportunidad en la atención especializada, fallas en la referencia y contra referencia y la necesidad de generar mejoras en la infraestructura de las IPS. Se reconoció que el buen trato del personal asistencial es un aspecto que incide de manera positiva en la percepción de la calidad. Conclusiones: Mejorar la calidad de los servicios sanitarios, requiere reconocer a los usuarios como el centro de la atención, con miras a la integralidad, continuidad, eficacia, eficiencia y la equidad de los servicios, bajo el imperante fundamental de la garantía y protección del derecho a la salud y a la vida digna de los pacientes.
Abstract Introduction: Perceptions of users from the health services are indispensable indicators for quality on the processes of health care. Objective: To know the perceptions of the users of a public network of the municipality of Pasto, Colombia versus the quality of health services at the first level of attention. Materials and methods: A qualitative research with a hermeneutic historical approach was conducted with 28 participants, who were users of rural and urban centers of care. The techniques developed for collecting the information were semi-structured interviews and a focal group. The research process addressed five dimensions: trust, reliability, responsibility, responsiveness and tangibility. Results: In the dimensions mentioned before, the difficulties of access by administrative and geographical aspects, problems in the opportunity in the specialized attention, faults in the reference and counter-reference and the necessity of infrastructure improvements in the IPS were identified as limitations in the quality. Moreover, it was recognized that the good treatment of the healthcare personnel is an aspect that affects in a positive way in the perception of the quality. Conclusions: Improving the quality of health services, requires recognizing users as the center of attention, with a view to the integrality, continuity, efficiency, efficiency and fairness of services, under the fundamental principle of guarantee and protection of the right to health and life worthy of patients.
