The implementation of patient navigation to improve mammography coverage and access to breast cancer care in Rio de Janeiro

Abstract

Este estudo avalia a introdução do Programa de Navegação do Paciente (PNP) em uma comunidade do município do Rio de Janeiro. Os objetivos são: estabelecer a viabilidade do PNP nesse contexto; identificar as barreiras ao rastreamento mamográfico; e assegurar cobertura mamográfica de 70% das mulheres recrutadas entre 50 e 69 anos. De março a setembro de 2018, foram recrutadas 678 mulheres com idade média de 58 anos da comunidade do Andaraí. O acompanhamento foi realizado pelo navegador de pacientes (NP) por telefone, e-mail e mensagens de texto. Doze por cento das mulheres recusaram-se a participar do PNP por razões culturais. As principais barreiras relatadas pelas mulheres foram: problemas do sistema com programação de cuidados de saúde (100%), problemas financeiros (64%), preocupações relacionadas à comunicação com a equipe médica (58%), medo (44%) e apoio social (14%). Foram obtidos 100% de satisfação com o PNP, e a meta de taxa de cobertura mamográfica foi superada, atingindo o percentual de 88%. O NP promoveu aumento na taxa de cobertura mamográfica, auxiliou na transmissão de informações de qualidade, reduziu o medo da mamografia e facilitou o acesso aos cuidados de saúde da mama. ABSTRACTThis study evaluates the Patient Navigation Program (Programa de Navegação do Paciente -PNP), which was introduced to a community in the municipality of Rio de Janeiro. The objectives were: to establish the viability of the PNP in this context; identify barriers to mammogram screening; and ensure mammogram coverage for 70% of women recruited between 50 and 69 years old. From March to September 2018, 678 women with an average age of 58 years old were recruited from the Andaraí community. Follow-up was performed through the patient browser (PB), by telephone, email and text messages. Twelve percent of women refused to participate in the PNP for cultural reasons. The main barriers reported by women were: systematic problems with health care programming (100%), financial problems (64%), concerns about communicating with medical staff (58%), fear (44%), and social support (14%). The PNP obtained 100% satisfaction, and the mammogram coverage rate goal was exceeded, reaching 88%. The PN promoted an increase in the rate for mammogram coverage, aided in the transmission of quality information, reduced individuals' fear of mammography, and facilitated access to breast health care.

Patient Navigation Improved Breast Cancer Outcomes Among Women in the Public System in Rio de Janeiro, Brazil

“…The initial goal was compliance with the law in at least 70% 6 , but chronic structural problems in Rio de Janeiro, such as a deficit of human resources and medical supplies, made it difficult to achieve this goal. Local managers were informed of the structural improvement needs involving partnerships from municipal, state, and federal powers [23][24][25] .…”

Patient navigation: fighting for the rights of breast cancer patients in Brazil

“…Seventy-five percent of the patients had advanced disease at diagnosis, 40% of the patients were considered young, that is, under 50 years of age, and 28% of the patients had a family history of BC, indicating the importance of expanding patient navigation for primary health care 19 . All patients with family risk reported that they were never instructed about the risks of the disease and how to protect their family members (change in lifestyle, screening for high-risk population, genetic counseling, genetic testing, and prophylactic interventions).…”

“…Effective actions in the management of care and acting on the main barriers to early detection of BC can favor adherence to personalized mammographic screening, timely investigation, and access to treatment. The PN experience in the Andaraí community, in the municipality of Rio de Janeiro, showed an increase in the tracking rate from 14% to 84%, and 100% of the lesions in 2018 were diagnosed in initial staging 19 .…”

Breast cancer screening in Primary Health Care in Brazil: a systematic review

“…Gioia S, Brigagão L, Torres C, Lima A, Medeiros M. 2019 (28) Establish the viability of patients' navigation program in a community in the city of Rio de Janeiro; identify barriers to mammographic screening; mammographic coverage of 70% of women recruited between 50 and 69 years old. MMG request by physicians.…”

“…By developing the skills expected in PHC beyond the gateway, the strategy of patient navigation by a Community Health Worker (CHW), in addition to showing the best result (28) , allowed us to move towards a vision that considered users and their subjectivities in the social process of building the disease. The patient navigation program consists of a trained team that helps patients to overcome modifiable barriers to care based on a personalized approach (35) .…”