The difficulty of access to senile cataract treatment in Aparecida de Goiânia – Goiás. Brazil

Abstract Objective: To identify the difficulties of patients with senile cataract in the access to the facectomy by Unified Health System ( SUS – Sistema Único de Saúde) in the Medical and Diagnostic Center (CEMED) of Aparecida de Goiânia. Methods: Cross-sectional and observational research with data collection from a standardized questionnaire applied preoperatively. Results: The sample consisted of 150 patients: 56% women and 44% men. The average age was 66.05 ± 9.21 years. Most (57.3%) had a previous diagnosis of cataract and, of these, 56.7% did not seek previous treatment. The reasons that prevented previous treatment were: difficulty in accessing the health service (43.5%), fear of surgery (18.8%) and lack of clinical condition for surgery (18.8%). 78.7% of patients would like to have surgery on the same day they are diagnosed with cataract. 21.3% were against this proposal, and the fear of surgery (65%) was the main reason for not performing the facectomy immediately. Regarding the impairment in activities of daily living (ADL), 20.6% could not read magazines and newspapers, in contrast, 20.6% reported no significant impairment in their ADL. Conclusion: The main difficulties in accessing senile cataract treatment were: difficulty in accessing the specialized health system, fear of the procedure, lack of clinical condition for surgery. Thus, it is necessary to promote good quality and affordable surgery; carrying out projects that facilitate diagnosis and treatment, that act in population education, promoting population awareness and stimulating the search for treatment.

摘要 目的：明确老年性白内障患者通过巴西统一健康系统（Unified Health System, SUS – Sistema Único de Saúde）在戈亚尼亚阿帕雷西达医疗诊断中心（CEMED）接受白内障手术的就诊障碍。
方法：采用横断面观察性研究设计，通过术前标准化问卷收集研究数据。
结果：本研究共纳入150例患者，其中女性占56%，男性占44%，平均年龄为66.05±9.21岁。57.3%的患者既往曾被诊断为白内障，其中56.7%未接受过既往治疗。导致患者未接受既往治疗的原因包括：医疗服务就诊困难（43.5%）、手术恐惧（18.8%）以及手术临床指征不足（18.8%）。78.7%的患者希望在确诊白内障当日即接受手术；21.3%的患者反对该方案，其中手术恐惧（65%）为拒绝即刻接受手术的主要原因。关于日常生活活动能力（Activities of Daily Living, ADL）受损情况：20.6%的患者无法阅读杂志与报纸，而另有20.6%的患者自述其日常生活活动能力无明显受损。
结论：老年性白内障患者就诊治疗的主要障碍包括：专科医疗系统就诊困难、手术操作恐惧以及手术临床指征不足。因此，有必要推广高质量且可负担的白内障手术；开展助力诊断与治疗的相关项目，进行人群健康宣教，提升公众健康意识，并鼓励患者主动寻求治疗。