Quality of Actions to Control Cervical Cancer in Bahia, Brazil

Abstract

Objective: To assess the quality of the actions to control cervical cancer (CC) and its correlates.

Methods: This is a cross-sectional study conducted from January to March 2019 in 19 municipalities in Bahia, Brazil, with a sample of 241 doctors and nurses from primary health care (PHC). Three dependent variables were chosen- "Performance of educational, promotion, prevention, and monitoring actions" (D1); "Access to diagnostic tests" (D2); "Non-occurrence of high grade cervical squamous intraepithelial lesions (HSIL)" (D3). Poisson regression with robust variance was used, adopting hierarchical input variables to estimate the prevalence ratios and confidence intervals of 95%.

Results: The following prevalence rates were found: D1 39.8% (95% CI: 33.8-46.2); D2 73.9% (95% CI: 67.9-79.1); and D3 46.4% (95% CI: 39.9-53.0). These dimensions remained associated with the dependent variables: D1- having professional training courses on the topic; consideration to ensure that collection takes place appropriately by a professional; and women having access to medical transport; D2- nurses treating low-grade lesions; D3- recording the Papanicolaou in electronic medical records; D1 and D2- professionals joining the service through public tender; D1 and D3- working in the PHC (≥ 2 years); D2 and D3- recording Papanicolaou in physical records; and performance of Papanicolaou by residents.

Conclusion: Better trained professionals and professionals working in stable work arrangements are associated with comprehensive actions to control CC. Such strategies indicate that investments in work management result in a more organized PHC and more solution-centered work processes. Therefore, working in the PHC for a longer time and nurses performing more clinical actions (collection and treatment) are favored by such organizational actions. Investments in diagnostic support contribute to perceptions of more comprehensive actions to control CC. <br />.

Keywords: Cervical cancer; Papanicolaou Test; Primary Health Care; Quality of Health Care; Screening.

Figure 1

Hierarchical Conceptual Model of Quality Analysis of the Actions Developed in the Line of Care for Cervical Cancer Control. Abbreviations: PHC, Primary Health Care; CHA, Community Health Agents; LSIL, Low Grade Squamous Intraepithelial Lesion; HFS, High Frequency Surgery; CC, Cervical Cancer