Avaliação de estratégias para detecção precoce do câncer de mama em mulheres atendidas na atenção básica em saúde: enfoque na estrutura e processo do serviço

Abstract

With regard to Women's Health, breast cancer deserves attention because it is the most common, except for non-melanoma skin cancer, and also for its magnitude. Evaluative studies are important to guide decision making by health managers in order to develop strategies that enable them to face problems that meet the quality of care. It is noticed that the planning and implementation of Public Policies in Primary Care is important, but also the evaluation of these programs with their consequent results. Therefore, it was decided to evaluate breast cancer control actions in women belonging to the target population for this cancer, in Primary Health Care. The structure-process-outcome triad is an important tool for assessing the quality of health services. The quality of care is based on three components, that is structure, process and outcomes. This is an evaluative study collected in 2018 in the city of Fortaleza, in Primary Health Care Units (UAPS). The sample consisted of 06 managers from selected UAPS, and a structure and process evaluation questionnaire was applied to them, supported by instruments related to the National Program for Access and Quality Improvement (PMAQ) and also 400 women assisted in these units, through early breast cancer detection actions identification form. Data were presented in tables and graphs using the statistical program R-35-1 and Pearson's chi-square test. In the application of the instrument with managers, regarding the structure, it was observed that the units are in compliance with many evaluated criteria, such as ambience, satisfactory lighting and privacy, identification and signaling of services offered to the population, rooms with computers and Internet, telephone, reception room and materials that are not usually lacking in routine, in accordance with the recommended. Although the structure was well evaluated in the conception of the managers who participated in the study, some items still present non-compliance, such as the identification of professionals through the use of badges, signs for people with disabilities, vehicle in the unit, waiting rooms with sufficient seats, doctors on all teams. Regarding the process, although actions directed to breast cancer are performed, it was observed that there are still difficulties in some evaluated questions: team meetings happen, but not at recommended frequency, there is the record of information with examination protocols tracking, but effective referral and counter-referral flow is still lacking. Regarding the results, the average of the interviewees was 58.8 years old, mostly married (38.2%), with elementary school 1 complete or elementary 2 incomplete (31%), who had no occupation at the moment (48.3 %) and also did not have health insurance (89.8%). As for the Breast Clinical Examination (ECM) most reported not performing annually (56.3%). It is noteworthy that all interviewees should, according to ministerial recommendations, do it each year. It should be emphasized the increase in the number of ECM performed in the last two years and its close relationship during gynecological prevention exams. Regarding mammography, although the majority received the exam request (55.3%), it is still significant that they did not receive it. Redials and fouls are not common. Regarding the association of variables, education was the one that obtained the most significance related to the clinical breast exam, interval for mammography, among others. The study concluded that despite improvements, structure and processes should be reviewed, as well as better targeting actions aimed at professionals and women in the target group to qualify the actions recommended by the Brazilian protocol and consequently to breast cancer control. The study will serve as subsidies for the development of new research on the subject, as well as for the planning of strategies, by managers and professionals of Primary Care, aiming at improving care aimed at controlling this cancer.