Instituto Nacional del Cáncer

Transcription

1 Instituto Nacional del Cáncer Dra. Julia Ismael Septiembre 2018

2 The INC is responsible for the development and implementation of health policies, as well as the coordination of integrated actions for cancer prevention and control in the country.

3 Objectives To contribute to the reduction of cancer incidence and mortality in Argentina To improve the quality of life of cancer patients.

4 Prevention, early detection and treatment National screening programs Testing the asymptomatic population to detect a disease or a risk factor

5 CRC Mortality

6 Epidemiology: Mortality

7 Background: diagnosis of the situation 2011 Absence of a programmatic framework Limited access and coverage of the target population, mostly occassional screening. Underreporting / lack of identification of risk groups Lack of an information system for program monitoring and evaluation. Lack of practice guidelines Underutilization of physical resources. Underutilization of human resources.

8 Basic Conditions Screening Program High coverage of the target population Screening with good quality test Adequate treatment and monitoring of people with precancerous lesions and cancer Karsa L, Lignini TA, Patnick J et al. (2010) Best Pract Res Clin Gastroenterol; 24:

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14 Programmatic definitions Average risk asymptomatic without familial or personal history y High risk Symptomatic Personal or familial history (adenoma, CCR, inflammatory disease) VCC UDV

15 Main working lines of the PNCCR Quality Human resources training Process quality control Clinical Practice Guidelines Monitoring Indicators Information System (SITAM). Coverage Communication Reference counter-referralm(1st y 2nd level) High screening coverage & access to treatment

16 Quality Human resources training Process quality control Clinical Practice Guidelines Alta Cobertura del Tamizaje y acceso al tratamiento and a

17 Quality Human resources training Process quality control Clinical Practice Guidelines Alta Cobertura del Tamizaje y acceso al tratamiento and a

18 Quality Human resources training Process quality control Clinical Practice Guidelines

19 Monitoring Indicators Information System (SITAM).

20 Coverage PNCCR Communication Reference counter-referralm(1st y 2nd level) High screening coverage & access to treatment 20

21 Coverage Communication Reference counter-referralm(1st y 2nd level) High screening coverage & access to treatment Hombres y Mujeres años c/cobertura pública de salud F. riesgo y síntomas. CAP Riesgo incrementado Población General Asintomática Colonoscopia Unidad de Diagnóstico y vigilancia Devolución de la muestra Entrega de TSOMFI e indicaciones Lectura Gestión de Turnos 21

22 Coverage Communication Reference counter-referral (1st y 2nd level) High screening coverage & access to treatment Communication strategies adapted to the characteristics of the population Workshops with sanitary agents Equipment training of health for active search Navigation strategy For the search of person with pathological diagnosis and that require follow-up and treatment

23 Screening program evolution TSOMFI 2014 PNCCR 23

24 2015 PNCCR 24

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27 Cantidad TSOMFI realizados Total tests performed PO: Cantidad TSOMFI realizados por año Año 27

28 Indicator Acceptable goal Results Desirable goal Coverage 40% 70% 3,4% Misiones 9,7% Tucumán FIT % first round 36% Misiones 23% Tucumán ,9% Misiones from the beginning 12,5% Tucumán from the beginning 25% Misiones 27% Tucumán 8% Misiones from the beginning 17,9% Tucumán from the beginning 15% Misiones 17% Tucumán Inadequate test 3% 1% 7% Misiones 3% Tucumán 4% Misiones 2% Tucumán 2% Misiones 2% Tucumán Colonoscopy in test + 70% 90% 40% Misiones 20% Tucumán 47% Misiones 37% Tucumán 78% Misiones 65% Tucumán Delays after test + 90% within 60 days 90% within 30 days 80% within 60 days in Misiones 65% Tucumán 59% within 60 daysin Misiones 39% Tucumán 19% within 60 daysiin Misiones 27% Tucumán

29 Total Colonoscopy Target Complete 85,41% 90-95% Complications 0,72% 0-0,35 Proper preparation 76,43% Anesthesia 94,5% non adenomatous polyp Total Colonoscopy IBD Findings No findings FIT + 5% ,00% 65,34% Average risk/no cancer FIT ,00% 70,73% 6% High risk ,32% 56,68% Symptomatic ,00% 65,74% serrate N Median 34,08 64,6225 adenoma 3% advanced adenoma 2% Other 16% PATHOLOGY 32% adenoma 36%

30 The pilot study provided a valuable systematization of health system requirements for the future work of implementation of CRC screening in Argentina that may be useful for other low and middle income countries with public health systems.

31 Getting our ducks in a row Poné el carro en movimiento que los melones se acomodan solos

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33 Stewardship Implementation framework Presence of political will to implement the project. Strategic leadership Commitment of relevant stakeholders Consensus and participation in the programme of national scientific societies Communication actions towards the community Organizational Health personal training (CHWs, endoscopists) Definition of an active search strategy (relevance of CHWs role) Definition, characterization and consolidation of screening, diagnosis and treatment services network Diagnosis and treatment accessibility assurance (relevance of navigators role) Data collection system Technical Consensus about the value and utility of the strategy Acceptability of the strategy Financial Sustainable financing availability Leon N, Schneider H, Daviaud E. Applying a framework for assessing the health system challenges to scaling up mhealth in South Africa. BMC Medical Informatics and Decision Making. 2012;12:123

34 Integration of the programs primary level of care primary level of care

35 Muchas gracias!

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