Advances and weaknesses of the work process of the oral cancer care network in Brazil: A latent class transition analysis

Abstract

Objective To analyse the provision of oral cancer (OC) care services in the Dental Specialties Centers (Centros de Especialidades Odontológicas‐CEO) in Brazil and identify changes over two cycles of external evaluation of the Program for the Improvement of Access and Quality‐PMAQ, in 2014 and 2018. Method This is a nationwide panel ecological study, including 916 CEO. Data from interviews with managers and dentists of the CEO were used, including variables related to training on OC, clinical protocols, biopsies, referral for diagnosis and treatment, and registration of users with OC. We carried out Latent Transition Analysis (LTA) to identify patterns (latent status LS) of service adequacy and work processes’ changes between the two assessment cycles. We tested models with three, four, and five LS, selecting the one with the best conceptual interpretability and good model fit parameters. Data from the LS were plotted on choropleth and hotspots maps in Brazil allowing us to identify areas with the better or worse provision of specialized OC services. Results The model with four LS was chosen. The four LS were named: 1.’Most indicators inadequate for OC care’ (the worst); 2. ‘Most indicators suitable for OC care’ (the best); 3. ‘CEO with a poor relation with Primary Health Care (PHC) services’; and 4. ‘CEO with a poor relation with tertiary hospital services’. The comparison of the LS transition between the two cycles revealed that 419 (45.7%) CEO remained in the same LS (1→1, 3→4, 2→2); 228 (24.9%) switched to a worse status (2→1, 2→4, 3→1) and 269 (29.4%) switched to a better LS (1→2, 1→4, 3→2). While the majority of the CEO improved, we identified a decline of 17.8% in those who reported performing biopsies and 18.3% in the number of CEO that had hospitals for referring confirmed OC cases. Almost all Brazilian states had CEO that improved the work process. The Southeast and South regions had the highest percentage of CEO with the better work process in both cycles. Hotspots showed areas concentrating improvements in the work process in the Northeast region. However, some hotspots in the North revealed some CEO where the work process deteriorated or remained unsatisfactory. Conclusions There are regional inequities in the provision of OC care in CEO. Most services improved their work process or remained stable. However, the biopsies and the referral to hospital care for confirmed cases declined, indicating that CEO need to improve planning and care provision to reduce OC morbimortality.

Can predictive factors determine the time to treatment initiation for oral and oropharyngeal cancer? A classification and regression tree analysis

“…PHC, through the Basic Health Units (BHU), works on health promotion, prevention and control of risk factors, screening, and initial diagnosis of OOC [ 29 ]. When potentially malignant lesions are identified at PHC, patients are referred to secondary (Dental Specialties Centers—DSC) or tertiary levels of care for diagnostic confirmation through biopsy [ 12 , 20 , 29 ]. After confirming the diagnosis of malignancy, patients are referred to highly complex Oncology Centers or Units to undergo oncological surgery, radiotherapy, and/or chemotherapy.…”

“…Concerning the health system, the adult population’s difficult access to dental care and the lack of coordinated actions at the different care levels (primary, secondary, and tertiary) [ 11 , 12 ] can influence the late onset of treatment. The coordination of cancer care involves everything from health policies, organizational aspects of services, appropriate infrastructure, and prepared human resources to socioeconomic issues in the health system context [ 5 ].…”

Oral cancer care in the “Metropolitan I” health region in the state of Rio de Janeiro, Brazil: enabling and constraining factors

“…The interviewees highlighted that the small number of accredited cancer treatment centers in the state and high demand for treatment were key constraining factors for access to treatment. A nationwide study showed that the number of CEOs with hospitals that they could refer cases of oral cancer to fell by 18.3% between 2014 and 2018 32 .…”

Atenção ao câncer bucal na região de saúde Metropolitana I do Rio de Janeiro, Brasil: fatores facilitadores e coercitivos

“…O pequeno número de unidades habilitadas para tratamento do câncer no estado e a alta demanda por tratamento foram apontados pelos entrevistados como principais fatores de restrição do acesso ao tratamento. Em estudo nacional, identificou-se declínio de 18,3% no número de CEO que tinham hospitais para encaminhar os casos confirmados de câncer bucal entre os anos de 2014 e 2018 32 .…”