Evaluability study of actions for early detection of breast cancer in primary care

Krann, Rafaela; Colussi, Claudia Flemming

doi:10.1590/0103-1104202313707I

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ORIGINAL ARTICLE • Saúde debate 47 (137) • Apr-Jun 2023 • https://doi.org/10.1590/0103-1104202313707I copy

Evaluability study of actions for early detection of breast cancer in primary care

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The article aims to develop an evaluative model of actions for the early detection of breast cancer in primary care. This evaluability study was conducted through document analysis, literature review, and consensus meeting stages to prepare the evaluative matrix. The result was the development of the Analysis and Judgment Matrix, composed of 14 indicators aggregated into two dimensions. Applying the evaluative model will allow the identification of the weaknesses and strengths of actions for the early detection of breast cancer.

KEYWORDS
Health evaluation; Primary Health Care; Breast neoplasms

DOCUMENT	CONTENT	CONTRIBUTION
Ordinance MS/GM No. 399 of February 22, 2006.	Among the priorities of the Pact for Life, a commitment among SUS managers, aims at goals for breast cancer control.	Description, objectives, and goals of the program.
Primary Care Notebooks, No. 13. Control of cervical and breast cancers (2013).	It contributes to organizing the Cervical and breast Cancer Care Network in the Unified Health System (SUS). It aims to guide care for women, technically subsidizing primary care professionals.	Description, organization, objectives, and operation of the Program.
Ordinance MS/GM No. 483 of April 1, 2014.	It redefines the Health Care Network for People with Chronic Diseases within the Unified Health System (SUS).	Program regulations, goals, objectives. Construction of the Logical Model and Theoretical Model.
Ordinance MS/GM No. 874, of May 16, 2013.	It establishes the National Policy for the Prevention and Control of Cancer in the Health Care Network of People with Chronic Diseases in the Unified Health System (SUS).	Description, organization, objectives, and operation of the Program.
Ordinance MS/GM No. 3,394, of December 30, 2013.	It promotes monitoring actions related to early detection, diagnostic confirmation, and the start of treatment through the Cancer Information System (SISCAN).	Program Normative, goals, objectives, activities, and results.
Strategic Action Plan to Combat Non-communicable Chronic Diseases (NCDs) in brazil, 2011– 2022 (2011).	It proposes national goals to increase mammography coverage in women aged 50 to 69; improve breast cancer screening actions; and universalize mammography screening for all women.	Program Normative, goals, objectives, activities, and results.
Guideline for the early detection of breast cancer in brazil (2015).	It establishes guidelines to expand and qualify the early detection of breast cancer, both relative to the organization of the line of care, as well as to support professionals in clinical practices.	Description, organization, objectives, activities, and results. Construction of the Logical Model and Theoretical Model.

	Indicator	Measures	Parameters	Source
Organizational Policy Dimension	Sufficiency of Professionals	Perception of the bHu coordination on the sufficiency of the workload of professionals working at the bHu (Physician and nurse)	Satisfactory (10 pts) Partial (5 pts) Unsatisfactory (0 pts)	Unit coordination
		Perception of bHu coordination on ubS opening hours*The schedule is appropriate to the health needs of the population of the territory	Satisfactory (10 pts) Partial (5 pts) Unsatisfactory (0 pts)
		Percentage of the completeness of the teams working at the bHu in the city	Transformation of the percentage of complete teams in the municipality into scores following the proportion (100%=10 pts)
		Percentage of coverage of teams in the city	Transformation of the percentage of coverage of the teams in the city into score following the proportion (100%=10 pts)
	Professional Qualification	Conducting training on the functioning of the municipal network on the entry of professionals	Yes (10 pts) / No (0 pts). Training is offered on the entry regarding the operation of the municipal network	Unit coordination
		Obligation of training on entry of professionals	Yes (10 pts) / No (0 pts) Participation in the training is mandatory on the entry of professionals
		Qualification actions on early detection of breast cancer	Yes (10 pts) / No (0 pts) Qualification actions on the early detection of breast cancer are understood as: permanent education on the subject; team meetings, forum, and lectures within the health unit
	Physical Structure of the Health Center	Perception of the bHu coordination on the adequacy of the physical structure of the Health Center to conduct health actions	Adequate (10 pts:); Partially (5 pts); Inadequate (0 pts)	Unit coordination
	Physical Structure of the Health Center	Existence of: 1. Waiting room (1 pt) 2. Office with bed (2 pts) 3. Office with bathroom (2 pts) 4. Room for collective activities/ Meeting room (2 pts) 6. Computer with Internet access (1 pt)	Adequate (10 pts): 6 to 8 points Partially adequate (5 pts): 3 to 5 points Inadequate (0 pts): less than 3 points.
	Regulation of access to specialized services	Existence of a central regulator for specialized services and Therapeutic Diagnostic Support Services (TDSS)	Yes (10 pts) / No (0 pt)	Unit coordination
	Regulation of access to specialized services	Time elapsed between the request for the examination and the return of the woman to the Health Center	Up to 30 days (Good) From 31 to 60 days (Regular) 61 days or more (Poor)
	Adequacy of the offer of specialized services and Therapeutic Diagnostic Support Services (TDSS)	Waiting time for imaging tests (mammog-raphy)	Good (up to 30 days) (10 pts) Regular (31 days to 60 days) (5 pts) Poor (61 days or more) (0 pts)	City Management
		Waiting time for consultation with mastolo-gist	Good (up to 30 days) (10 pts) Regular (31 days to 60 days) (5 pts) Poor (61 days or more) (0 pts)
		Availability of mammography exam	Satisfactory (10 pts) (Availability of mammography exam in the city) Partial (5 pts) (Availability of mammography exam in the network)Unsatisfactory (0 pts) (No availability of mammography exam in the city and the network)	IBGE/CNES
	Reference and counter-reference	Existence of counter-reference after referral to specialized service	Always (10 pts)Most often (8 pts)Sometimes (5 pts)Rarely (1 pt)Never (0 pt)	Unit coordination
	Availability of Information	Requirement to complete the SISCAN Information System requisition	Yes (10 pts) / No (0 pts)	City Management
	Availability of Information	Monitoring the completion of the SISCAN Information System request	Yes (10 pts) / No (0 pts)
	Monitoring of actions aimed at early detection of breast cancer	Existence of indicators for monitoring actions aimed at the early detection of breast cancer	Yes (10 pts) / No (0 pts)	City Management
		Follow-up of monitoring indicators of actions aimed at early detection of breast cancer	Yes (10 pts) Partial (5 pts) No (0 pts)
		Conducting planning and organization of actions aimed at early detection of breast cancer based on the evaluation of the selected indicators	Very often (10 pts) Often (7.5 pts) Occasionally (5 pts) Rarely (2.5 pts) Never (0 pts)
Care Delivery Dimension	Knowledge of the Territory	Percentage of microareas covered by PHC	Good (75%) (10 pts) Regular (50 to 75%) (10 pts) Poor (<50%) (0 pts)	Unit coordination
	Organization of the agenda	Identification and registration of women of the target age who are not undergoing mammographic screening	Yes (10 pts) / No (0 pts)	Unit coordination
	Organization of the agenda	Ensuring follow-up appointments for users diagnosed with breast cancer	Yes (10 pts) Partial (5 pts) No (0 pts)
	Women’s healthcare work process	Conducting active searches for women in the target population	Yes (10 pts) / No (0 pts)	Unit coordination
		Conducting follow-up consultations for women referred to specialized services	Yes (10 pts) Partial (5 pts) No (0 pts)
		Conducting health education actions to raise awareness of the population on the subject Includes: Waiting rooms, educational lectures in the community, dissemination of the theme in local communications, pink October action.	Yes (10 pts) / No (0 pts)
		Use of protocol and guidelines aimed at early detection of breast cancer	Always (10 pts) Most often (7.5 pts) Sometimes (5 pts) Rarely (2.5 pts) Never (0 pts)
	Women’s healthcare work process	Registration of women who underwent mammography in electronic medical records and/or follow-up forms	Yes (10 pts) / No (0 pts)	Unit Coordinator
		Conducting the checklist in women’s health consultations Medical and nursing care checklist: - Anamnesis; - Physical examination of the breasts; - Search for risk factors (hereditary, behavioral/environmental, endocrine) for breast cancer development. - Request for mammography examination for women between 50 and 69 years old every 2 years	Always (10pts) Most often (7.5pts) Sometimes (5pts) Rarely (2.5pts) Never (0 pts)	Unit Coordinator
		Home care for women in palliative care	Yes (10 pts) / No (0 pts)
	Interdisciplinary work	Participation of different professionals in the organization of educational activities Includes: Waiting rooms, educational lectures in the community, pink October actions, team meetings	Always (10pts) Most often (7.5pts) Sometimes (5pts) Rarely (2.5pts) Never (0 pts)	Unit Coordinator
	Interdisciplinary work	Multi-professional team support for users in breast cancer treatment It is understood as multiprofessional support: psychologists, physiotherapists, nutritionist, pharmacist	From 4 professionals (10 pts) From 2 to 3 professionals (5 pts) From 1 professional (1 pts)
	Early diagnosis of breast cancer	Average time between performing diagnostic mammography and its result	Satisfactory: 0-30 day (10 pts) Partial: 31 to 60 days (5 pts) Unsatisfactory: > 60 or cannot inform (0 pts)	Unit Coordinator
	Early diagnosis of breast cancer	Percentage of mammographies classified as bI-RADS 4 or 5 of total diagnostic mammographies	Satisfactory: < 5% (10 pts) Unsatisfactory: >5% (0 pts)	SisMama/ Siscan
	Screening	Percentage of the target population that underwent mammography examination at the indicated frequencyCalculation: Number of women aged 50 to 69 years who underwent screening mammography in the last two years, in a given place and period x 100/ Number of women aged 50 to 69 years, in the respective place and period	70% satisfactory 50 to 69% regular < 49% unsatisfactory	Siscan e IBGE
		Percentage of mammography screening according to indication for women aged 50 to 69 years	Satisfactory: 53% or more (10 pts) Partial: 25 to 53% (5 pts) Unsatisfactory: < 25% (0 pts)	Siscan/ SisMama/ SIA/ SuS
		Calculation: No. of screening mammographies in women aged 50 to 69 years, residing in a given location and period x 100 / Total No. of screening mammographies in the respective location and period	*In 2013, the value presented for brazil was 53%
		Average time between screening mammog-raphy and its result	Satisfactory: 0-30 days (10 pts) Partial: 31 to 60 days (5 pts) Unsatisfactory: > 60 days (0 pts)	SisMama/ Siscan

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[1] Conflict of interests: non-exixtent