A carregar...
| Nome: | Descrição: | Tamanho: | Formato: | |
|---|---|---|---|---|
| 1.44 MB | Adobe PDF |
Autores
Orientador(es)
Resumo(s)
RESUMO - O cancro colorretal (CCR) é uma das principais causas de morbilidade e mortalidade a nível mundial e considerado um problema prioritário de saúde pública (Adhikari et al., 2022). Em Portugal, o Programa Nacional para a Prevenção do CCR recomenda o rastreio por Pesquisa de Sangue Oculto nas Fezes (PSOF), seguido de colonoscopia nos casos positivos. A efetividade dos programas de rastreio do CCR depende da cobertura populacional, da adesão e da articulação eficiente entre cuidados primários e hospitalares. Este estudo foi realizado na Unidade Local de Saúde Amadora/Sintra com o objetivo de avaliar o desempenho dos modelos de rastreio de base populacional e oportunístico do CCR e de caracterizar o percurso assistencial dos utentes.
Trata-se de um estudo observacional, transversal baseado na análise de dados quantitativos referentes a 2023 e 2024. A população incluiu utentes elegíveis para rastreio entre os 50 e os 74 anos sem diagnóstico prévio de CCR. Analisaram-se e compararam-se indicadores-chave dos dois modelos de rastreio por Unidade Funcional (UF): cobertura, proporção de positivos no teste PSOF e de colonoscopias realizadas e a média de dias entre etapas do percurso. Avaliou-se ainda o seguimento hospitalar após resultado positivo.
Os resultados revelaram diferenças significativas entre os modelos. A cobertura média no rastreio de base populacional foi de 8,4%, enquanto no modelo oportunístico atingiu 22,9%, ambas abaixo da meta europeia de 65%. Apenas 39,8% dos utentes com PSOF positivo realizaram colonoscopia, valor inferior ao objetivo de 90% definido pelas diretivas europeias. Os tempos médios entre o resultado PSOF positivo e colonoscopia foram de 58 dias no modelo oportunístico e 81 dias no populacional. A percentagem de casos seguidos em colonoscopia referenciados para contexto hospitalar foi de 5,8%, com um elevado número diagnósticos a situaram-se no estadio II ou superior.
O rastreio oportunístico revelou melhor desempenho em cobertura e resposta, mas menor equidade. O modelo populacional mostrou limitações na resposta hospitalar. Ambos evidenciaram fragilidades no seguimento para colonoscopia. A coexistência dos dois modelos, suportada por softwares interoperáveis, circuitos padronizados e estratégias inclusivas, poderá melhorar a continuidade assistencial e potenciar ganhos em saúde.
ABSTRACT - Colorectal cancer (CRC) is one of the leading causes of morbidity and mortality worldwide and is considered a major public health priority (Adhikari et al., 2022). In Portugal, the National Program for the Prevention of CRC recommends screening through Fecal Occult Blood Testing (FOBT), followed by colonoscopy in positive cases. The effectiveness of CRC screening programs depends on population coverage, screening adherence and efficient coordination between primary and hospital care. This study was conducted at the Amadora/Sintra Local Health Unit and aimed to evaluate the performance of systematic and opportunistic CRC screening models and to characterize patients’ care pathways. We performed a cross-sectional observational study based on quantitative data from 2023 and 2024. The population included eligible individuals aged 50-74 years without a prior CRC diagnosis. Key indicators were analyzed and compared between the two screening models across primary care units: coverage, proportion of positive FOBT results, proportion of colonoscopies performed and mean time intervals between screening stages. Hospital follow-up after positive results was also assessed. Results showed significant differences between models. Average coverage in the population-based screening was 8.4%, while the opportunistic model reached 22.9%, both far below the European target of 65%. Only 39.8% of individuals with positive FOBT underwent colonoscopy, well below the 90% benchmark set by European guidelines. The mean interval between positive FOBT and colonoscopy was 58 days in the opportunistic model and 81 days in the population-based model. Among those undergoing colonoscopy, 5.8% were referred to hospital care, with a high proportion of diagnoses at stage II or higher. Opportunistic screening demonstrated better coverage and responsiveness but lower equity. Systematic screening revealed gaps in hospital follow-up. Both models highlighted weaknesses in colonoscopy follow-up. Integrating the two approaches, supported by interoperable software, standardized care pathways, and inclusive strategies, may enhance care continuity and improve health outcomes.
ABSTRACT - Colorectal cancer (CRC) is one of the leading causes of morbidity and mortality worldwide and is considered a major public health priority (Adhikari et al., 2022). In Portugal, the National Program for the Prevention of CRC recommends screening through Fecal Occult Blood Testing (FOBT), followed by colonoscopy in positive cases. The effectiveness of CRC screening programs depends on population coverage, screening adherence and efficient coordination between primary and hospital care. This study was conducted at the Amadora/Sintra Local Health Unit and aimed to evaluate the performance of systematic and opportunistic CRC screening models and to characterize patients’ care pathways. We performed a cross-sectional observational study based on quantitative data from 2023 and 2024. The population included eligible individuals aged 50-74 years without a prior CRC diagnosis. Key indicators were analyzed and compared between the two screening models across primary care units: coverage, proportion of positive FOBT results, proportion of colonoscopies performed and mean time intervals between screening stages. Hospital follow-up after positive results was also assessed. Results showed significant differences between models. Average coverage in the population-based screening was 8.4%, while the opportunistic model reached 22.9%, both far below the European target of 65%. Only 39.8% of individuals with positive FOBT underwent colonoscopy, well below the 90% benchmark set by European guidelines. The mean interval between positive FOBT and colonoscopy was 58 days in the opportunistic model and 81 days in the population-based model. Among those undergoing colonoscopy, 5.8% were referred to hospital care, with a high proportion of diagnoses at stage II or higher. Opportunistic screening demonstrated better coverage and responsiveness but lower equity. Systematic screening revealed gaps in hospital follow-up. Both models highlighted weaknesses in colonoscopy follow-up. Integrating the two approaches, supported by interoperable software, standardized care pathways, and inclusive strategies, may enhance care continuity and improve health outcomes.
Descrição
Trabalho Final do Curso de Especialização em Administração Hospitalar
Palavras-chave
Cancro Colorretal Rastreios Adesão Diagnóstico precoce Percurso assistencial Colorectal Cancer Screening Screening adherence Early Diagnosis Care Pathway