Access to breast cancer care in a municipality in Bahia: the perspective of users, workers and managers

ABSTRACT This study aimed to evaluate the access of women with breast cancer to health care services in a medium-sized municipality in the interior of Bahia, from the perspective of users, workers and managers. This is a case study with a qualitative approach, carried out with women diagnosed with breast cancer, both in urban and rural areas. In addition, primary health care workers of medium and high complexity and municipal managers participated. The results were presented in two categories: Organization of the breast cancer care network and Access to breast cancer care in the health care network. In the first, the lack of a line of care for breast cancer stands out, insufficient health financing and fragility in the mechanisms of integration of the care network. In the second, ineffective mammographic screening, focusing on breast cancer care in the Pink October and difficulty accessing the exams and specialized procedures, such as consultation with a mastologist and breast puncture/biopsy. The plurality of evaluated perspectives allowed observing important gaps in the constitution of the care network for women with breast cancer, in which organizational problems feedback with those related to the care provided.摘要 本研究旨在从服务使用者、医护人员及管理者的视角，评估巴伊亚州内陆中型城市的乳腺癌女性患者获取医疗服务的现状。本研究为采用定性研究方法的案例研究，研究对象涵盖城乡两地确诊乳腺癌的女性患者；此外，承担中高复杂度医疗服务的基层医护人员及市政管理者也参与了本次研究。研究结果分为两大类别展开阐述：乳腺癌诊疗服务网络的组织架构，以及医疗服务网络中乳腺癌诊疗服务的可及性。在第一类范畴中，突出的问题包括缺乏乳腺癌专属诊疗专线、医疗经费投入不足，以及诊疗网络整合机制存在脆弱性。在第二类范畴中，存在乳腺钼靶筛查效能低下、仅在粉红十月（Pink October）乳腺癌防治宣传月期间才聚焦乳腺癌诊疗服务，以及患者难以获取相关检查与专科诊疗操作（如乳腺专科医师会诊、乳腺穿刺/活检）等问题。本次研究通过多视角评估，发现针对乳腺癌女性患者的诊疗网络构建存在显著短板，其中组织架构问题与实际诊疗服务问题彼此相互影响、互为因果。