Complex Care Systems in Developing Countries Breast Cancer Patient Navigation in Ethiopia
Complex Care Systems in Developing Countries Breast Cancer Patient Navigation in Ethiopia
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DOI：
10.1002/cncr.24776
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发表时间：
2010-02-01
期刊：
影响因子：
6.2
通讯作者：
Reeler, Anne
中科院分区：
文献类型：
--
作者：
Dye, Timothy D.;Bogale, Solomon;Reeler, Anne
背景技术背景：随着乳腺癌在全球的可见度和重要性的增加，特别是在发展中国家，确保各国加强和发展支持预防、诊断和治疗复杂慢性病的卫生系统是一个优先事项。了解乳腺癌患者如何利用卫生系统达到适当的护理水平，对于评估和改善各国卫生系统应对其人口中日益增加的乳腺癌负担至关重要。埃塞俄比亚加快了对乳腺癌的关注，扩大了临床和公共卫生工作，以便更早、更有效地诊断和治疗乳腺癌。方法：该项目使用混合方法评估医疗保健系统的患者导航，导致埃塞俄比亚癌症转诊医院（Tikur Anbessa医院[TAH]）的护理。总共采访了69名代表TAH整个乳腺癌临床人群的患者。研究结果：导航链有很大的差异，通常涉及3个或更多的护理节点，直到他们到达转诊医院，咨询传统治疗师的患者比其他人有更多的护理节点到达转诊医院，直接访问当地和地区医院的患者有最少的护理节点。病人报告说，他们从一个保健机构横向移动到另一个保健机构，或退回到较低的保健水平，有时因重新雇用传统治疗师而变得复杂。结论：可以简化埃塞俄比亚乳腺癌患者的护理系统，以便利患者获得该国现有的临床有效的诊断和治疗服务，主要是通过改善当地初级保健和医院提供基本乳腺癌服务的能力，并改善检测和转诊。Cancer 2010;116：577-85. (C)2009年美国癌症协会。
BACKGROUND: As the global visibility and importance of breast cancer increases, especially in developing countries, ensuring that countries strengthen and develop health systems that support prevention, diagnosis, and treatment of a complex chronic disease is a priority. Understanding how breast cancer patients navigate health systems to reach appropriate levels of care is critical in assessing and improving the health system response in countries to an increasing breast cancer burden in their populations. Ethiopia has accelerated attention to breast cancer, expanding clinical and public health efforts at diagnosing and treating breast cancer earlier and more efficiently. METHODS: This project used a mixed-method approach to assessing patient navigation of the healthcare system that resulted in care at the cancer referral hospital for Ethiopia (Tikur Anbessa Hospital [TAH]). In total, 69 patients representative of the entire breast cancer clinical population at TAH were interviewed. RESULTS: Navigation chains are widely divergent and typically involve 3 or more care nodes until they reach the referral hospital, Patients who consult traditional healers have significantly more care nodes to reach the referral hospital than others, and patients who have direct access to local and regional hospitals have the smallest number of care nodes. Patients report moving laterally from I health institution to another or regressing to lower levels of care, sometimes complicated by reinvolving traditional healers. CONCLUSIONS: The care system can be streamlined for breast cancer patients in Ethiopia to facilitate patient access to available and clinically effective diagnostic and treatment services in the country, largely through improving local primary care and hospital capacity to provide basic breast cancer services and improve detection and referral. Cancer 2010;116:577-85. (C) 2009 American Cancer Society.