Os descaminhos da Lei dos Sessenta dias e a realidade dos pacientes com neoplasias malignas
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Data
2019-12-18
Autores
Lombardo, Mariela Santos
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Universidade Estadual Paulista (Unesp)
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Introdução: O câncer é considerado um grave problema de saúde pública que afeta milhões de pessoas no mundo com agravantes indesejáveis. As taxas de mortalidade por câncer ocupam a primeira ou segunda posição em 172 países e terceiro, ou quarto lugar nos demais. De acordo com a Organização Mundial da Saúde, o câncer é uma preocupação crescente na saúde pública, e há perspectivas de aumento de novos casos para 21,6 milhões anualmente até 2030. Com o aumento da incidência da doença na população, maiores investimentos na prevenção, tratamento, gastos com a saúde e pesquisa foram instituídas no Brasil. Sendo assim, leis e políticas de saúde atuam para que o diagnóstico e início do tratamento sejam realizados em tempo hábil para o controle, e até mesmo a cura da doença. Nesse sentido, o Congresso Nacional preocupado com o aumento das doenças crônicas e degenerativas, entre elas o câncer, tem elaborado políticas públicas e leis que visam o atendimento prioritário em determinado espaço de tempo. Entretanto, o avanço na legislação, muitas vezes, não condiz com a realidade da assistência prestada na atenção à saúde, pois por mais que o governo faça, ainda há lacunas a serem preenchidas, visto que o acesso aos meios diagnósticos continua sendo desafiante. Deste modo, o Governo, em 2012 promulgou a Lei nº 12.732, denominada Lei dos Sessenta dias, a qual estabelece que o paciente com câncer tenha o direito de iniciar o tratamento em até sessenta dias, a partir do laudo patológico de diagnóstico da doença. Objetivo: Pretendeu-se compreender a experiência destes pacientes que chegam ao Hospital das Clínicas de Botucatu, segundo o tempo e o itinerário percorrido por eles na busca do serviço especializado, assim como a percepção de profissionais de saúde e gestores. Método: Trata-se de uma pesquisa qualitativa, sobre a experiência destes usuários pertencentes aos seguimentos do itinerário do Sistema Único de Saúde, profissionais de saúde e gestores municipais desde a atenção básica até o serviço especializado, para o cumprimento da Lei dos Sessenta Dias. O Hospital das Clínicas de Botucatu faz parte da rede regional de atenção às neoplasias malignas, atendendo 68 municípios pertencentes ao Departamento Regional de Saúde VI. As entrevistas foram gravadas, transcritas na íntegra e analisadas segundo o referencial metodológico da fenomenologia. A experiência dos participantes com o itinerário foi interpretada à luz do referencial teórico Alfred Schutz e da Lei dos Sessenta Dias. Resultados: Os dados salientam que o usuário cria o seu próprio caminho para chegar ao tratamento, embora exista a Rede Oncológica pactuada, este usuário utiliza do sistema misto (público-privado), na tentativa de agilizar o diagnóstico e tratamento. O pronto-socorro é reconhecido como porta de entrada para o tratamento, tanto para os usuários quanto para os profissionais e gestores, para a realização de exames iniciais até o diagnóstico definitivo. Há escassez na oferta de exames de alta complexidade, assim como falhas na prevenção, evidenciando falhas na Atenção Primária. Os entrevistados reconhecem que para o câncer o tempo é um fator determinante para a sobrevida. Há desconhecimento da legislação principalmente por parte dos usuários e profissionais de saúde, embora os gestores conheçam a legislação, não sabem se ela está sendo cumprida no tempo determinado. Conclusão: Embora haja uma rede preconizada, há diferentes caminhos que permitem o usuário chegar ao diagnóstico, enfrentando diversas barreiras, e na maioria das vezes sendo ativo no seu processo de cuidado. Ademais, é evidente a falta de um sistema de vigilância e monitoramento da doença, o usuário não é monitorado dentro da rede, embora existam sistemas e o prontuário eletrônico do cidadão, via E-sus, estes não são utilizados de forma a gerenciar o cuidado do usuário oncológico. Deste modo, somente a implantação da legislação não permite um acesso de qualidade e em tempo hábil para o portador de neoplasias malignas.
Introduction: Cancer is considered a serious public health problem that affects millions of people worldwide with unwanted aggravations. Cancer mortality rates rank first or second in 172 countries and third or fourth in the others. According to the World Health Organization, cancer is a growing public health concern, and there are prospects of increasing new cases to 21.6 million annually by 2030. With the increasing incidence of the disease in the population, greater investments in prevention, treatment, health expenses and research were instituted in Brazil. Thus, health laws and policies act to ensure that diagnosis and initiation of treatment are made in a timely manner to control and even cure the disease. In this sense, the National Congress, concerned about the increase of chronic and degenerative diseases, including cancer, has been elaborating public policies and laws that aim at the priority care in a certain period of time. However, the advance in legislation often does not match the reality of health care assistance, as much as the government does, there are still gaps to be filled, as access to diagnostics remains challenging. Thus, the Government, in 2012, promulgated Law No. 12,732, called the Sixty-Day Law, which establishes that the cancer patient has the right to start treatment within sixty days, based on the pathological report of diagnosis of the disease. Objective: It was intended to understand the experience of these patients who arrive at the Botucatu Clinics Hospital, according to the time and the itinerary followed by them in search of specialized service, as well as the perception of health professionals and managers. Method: This is a qualitative research on the experience of these users belonging to the Unified Health System itinerary, health professionals and municipal managers from primary care to specialized service, to comply with the Law of the Sixty Days. Botucatu Clinics Hospital is part of the regional malignant cancer care network, serving 68 municipalities belonging to the Regional Health Department VI. The interviews were recorded, transcribed in full and analyzed according to the methodological framework of phenomenology. The participants' experience with the itinerary was interpreted in the light of the theoretical framework Alfred Schutz and the Sixty Day Law. Results: The data point out that the user creates his own path to reach treatment, although there is the agreed Oncology Network, this user uses the mixed system (public-private), in an attempt to expedite diagnosis and treatment. The emergency room is recognized as a gateway to treatment for both users, professionals and managers, for initial examinations until definitive diagnosis. There is scarcity in the offer of high complexity tests, as well as failures in prevention, evidencing failures in Primary Care. Respondents recognize that for cancer time is a determining factor for survival. Users and health professionals are unaware of the legislation, although managers know the legislation, they do not know if it is being complied with on time. Conclusion: Although there is a recommended network, there are different ways that allow the user to reach the diagnosis, facing several barriers, and most often being active in their care process. In addition, the lack of a disease surveillance and monitoring system is evident, the user is not monitored within the network, although there are systems and the citizen's electronic medical record via E-sus, these are not used to manage care of the cancer user. Thus, only the implementation of the legislation does not allow a quality and timely access for patients with malignant neoplasms.
Introduction: Cancer is considered a serious public health problem that affects millions of people worldwide with unwanted aggravations. Cancer mortality rates rank first or second in 172 countries and third or fourth in the others. According to the World Health Organization, cancer is a growing public health concern, and there are prospects of increasing new cases to 21.6 million annually by 2030. With the increasing incidence of the disease in the population, greater investments in prevention, treatment, health expenses and research were instituted in Brazil. Thus, health laws and policies act to ensure that diagnosis and initiation of treatment are made in a timely manner to control and even cure the disease. In this sense, the National Congress, concerned about the increase of chronic and degenerative diseases, including cancer, has been elaborating public policies and laws that aim at the priority care in a certain period of time. However, the advance in legislation often does not match the reality of health care assistance, as much as the government does, there are still gaps to be filled, as access to diagnostics remains challenging. Thus, the Government, in 2012, promulgated Law No. 12,732, called the Sixty-Day Law, which establishes that the cancer patient has the right to start treatment within sixty days, based on the pathological report of diagnosis of the disease. Objective: It was intended to understand the experience of these patients who arrive at the Botucatu Clinics Hospital, according to the time and the itinerary followed by them in search of specialized service, as well as the perception of health professionals and managers. Method: This is a qualitative research on the experience of these users belonging to the Unified Health System itinerary, health professionals and municipal managers from primary care to specialized service, to comply with the Law of the Sixty Days. Botucatu Clinics Hospital is part of the regional malignant cancer care network, serving 68 municipalities belonging to the Regional Health Department VI. The interviews were recorded, transcribed in full and analyzed according to the methodological framework of phenomenology. The participants' experience with the itinerary was interpreted in the light of the theoretical framework Alfred Schutz and the Sixty Day Law. Results: The data point out that the user creates his own path to reach treatment, although there is the agreed Oncology Network, this user uses the mixed system (public-private), in an attempt to expedite diagnosis and treatment. The emergency room is recognized as a gateway to treatment for both users, professionals and managers, for initial examinations until definitive diagnosis. There is scarcity in the offer of high complexity tests, as well as failures in prevention, evidencing failures in Primary Care. Respondents recognize that for cancer time is a determining factor for survival. Users and health professionals are unaware of the legislation, although managers know the legislation, they do not know if it is being complied with on time. Conclusion: Although there is a recommended network, there are different ways that allow the user to reach the diagnosis, facing several barriers, and most often being active in their care process. In addition, the lack of a disease surveillance and monitoring system is evident, the user is not monitored within the network, although there are systems and the citizen's electronic medical record via E-sus, these are not used to manage care of the cancer user. Thus, only the implementation of the legislation does not allow a quality and timely access for patients with malignant neoplasms.
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Palavras-chave
Neoplasias, Acesso aos serviços de saúde, Enfermagem, Legislação, Neoplasms, Qualitative research, Health service accessibility, Legislation, Nursing