RESUMO
BACKGROUND: Interventions aimed at improving access to timely cancer care for patients in low- and middle-income countries (LMIC) are urgently needed. We aimed to evaluate a patient navigation (PN) program to reduce referral time to cancer centers for underserved patients with a suspicion or diagnosis of cancer at a public general hospital in Mexico City. MATERIALS AND METHODS: From January 2016 to March 2017, consecutive patients aged >18 years with a suspicion or diagnosis of cancer seen at Ajusco Medio General Hospital in Mexico City who required referral to a specialized center for diagnosis or treatment were enrolled. A patient navigator assisted patients with scheduling, completing paperwork, obtaining results in a timely manner, transportation, and addressing other barriers to care. The primary outcome was the proportion of patients who obtained a specialized consultation at a cancer center within the first 3 months after enrollment. RESULTS: Seventy patients (median age 54, range 19-85) participated in this study. Ninety-six percent (n = 67) identified >1 barrier to cancer care access. The most commonly reported barriers to health care access were financial burden (n = 50) and fear (n = 37). Median time to referral was 7 days (range 0-49), and time to specialist appointment was 27 days (range 1-97). Ninety-one percent of patients successfully obtained appointments at cancer centers in <3 months. CONCLUSION: Implementing PN in LMIC is feasible, and may lead to shortened referral times for specialized cancer care by helping overcome barriers to health care access among underserved patients. IMPLICATIONS FOR PRACTICE: A patient navigation program for patients with suspicion or diagnosis of cancer in a second-level hospital was feasible and acceptable. It reduced patient-reported barriers, and referral time to specialized appointments and treatment initiation were within international recommended limits. Patient navigation may improve access to care for underserved patients in developing countries.
Assuntos
Detecção Precoce de Câncer , Neoplasias/epidemiologia , Navegação de Pacientes , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Neoplasias/diagnóstico , Neoplasias/patologia , Neoplasias/terapia , Pobreza , Encaminhamento e Consulta , Populações VulneráveisRESUMO
Los padecimientos alérgicos están genéticamente determinados y afectan del 20 al 30 por ciento de la población general en países desarrollados; en la última década la prevalencia se ha incrementado. El desequilibrio manifiesto en los padecimientos atópicos se encuentra en las células presentadoras de antígeno (monocitos y células B) y en los linfocitos T CD4+. La asociación de moléculas como CD80, CD 86 (moléculas co-estimulatorias) en monocitos y células B; y CD30, CD62L, ALL, CD11a, CD28, CD124 y CD152 en CD4+, ha demostrado ser de particular interés en padecimientos atópicos. Sin embargo, no se encontró una diferencia estadísticamente significativa entre pacientes y controles y entre reto nasal con solución salina y alergeno. Por esto se sugiere que los cambios en la activación, proliferación y cooperación se dan en el sitio de la lesión, sin una aparente repercusión en las células de la sangre periférica.