Rastreamento do câncer do colo do útero: uma análise da continuidade do cuidado com base em sistemas de informações do SUS.

Abstract

The aim of this study was to assess the procedures production of cervical cancer care procedures in Brazil and analyze health care history of women who presented cervical cancer screening abnormalities in São Paulo state, emphasizing the times intervals until the diagnostic investigation and the first treatment. The study was conducted in two stages: the first one evaluated the aggregated data publicly available in the information systems of the Brazilian Unified Health System (SUS), estimating the need for procedures to screen and follow women on target age, based on the current national guidelines, and from then on, calculated the deficit or excess of procedures performed in the year 2015. In the second stage a follow-up study was carried out, based on secondary data recorded in the information systems of the SUS from the state of São Paulo, in the period from 2010 to 2013. The cohort was composed of women aged 25 years and older, living in São Paulo, and who had a high-grade intraepithelial lesion or more severe result in a screening exam recorded in the Information System of Cervical Cancer (SISCOLO) in 2010. The follow-up was carried out by probabilistic record linkage between databases of the systems that register diagnosis procedures (SISCOLO and SUS Outpatient Information System - SIA), treatment procedures (SIS and Hospital Information System of SUS - SIH) and deaths (Mortality Information System). The median times between screening and diagnostic investigation and between diagnosis and treatment were calculated using the Kaplan-Meier method, and the Cox proportional hazards model was used to analyze the factors associated with shortest time intervals. Due to the unavailability of individual sociodemographic information considered relevant, contextual variables were included in the analysis, referring to the municipalities of women's residence. In addition, considering that the organization of the health care system plays an important role in the women s acess to the health system, the random effect of women's residence region was included in the model. The results indicated a shortage of procedures for the cervical cancer screening and treatment in all brazilian regions, especially diagnostis procedures, which had a defficit close to 50%. In São Paulo, the median time between the screening and the diagnostic investigation was 200 days (IC95% 180-230), above the internationally recommended standards, by organized scrrening programs. The median time to treatment (66 days, IC95% 59-73) was below that recommended by Brazilian Ministry of Health. The loss of follow-up was significant, with important regional variations. It was concluded that the country has a significant deficit in the provision of procedures for the cervical cancer care and that access to diagnostic investigation is one of the main obstacles of the cervical cancer care in Brazil. The qualification of care to ensure continuity of care for women with screening abnormalities is critical to ensure expected changes in the current epidemiological scenario.