Adherence of Mexican physicians to clinical guidelines in the management of breast cancer: Effect of the National Catastrophic Health Expenditure Fund

Abstract

AimTo assess the adherence of physicians to the Medical-Care Guidelines for Malignant Breast Tumors in Mexico, before and after the allocation of federal subsidies from the Catastrophic Health Expenditure Fund (FPGC by its Spanish initials) to accredited hospitals, a strategy implemented with the view of offering free treatment to women with breast cancer (BC).Material and methodsBased on a cross-sectional design, we gathered information on 479 BC patients who had been attended to at in four FPGC-accredited hospitals. Analysis centered on those treated within either three years before or three years after the accreditation of their attending hospitals. The four hospitals analyzed were located in the North, South, West and Center of the country. Information on all medical procedures performed during treatment was drawn from hospital medical records. Information on the socio-demographic characteristics of the patients was obtained by means of face-to-face interviews conducted in their homes.ResultsAdherence of physicians to the Guidelines grew by 12.8 percent (from 43.4 to 56.2 percent) after FPGC accreditation (p<0.001) and varied according to the clinical stage of the disease, with much lower levels of adherence observed in the advanced stages (p<0.05).ConclusionsThe FPGC strategy increased the adherence of physicians to the Medical-Care Guidelines for Malignant Breast Tumors in Mexico.

What is the impact of clinical guidelines on imaging costs?

“…[ 19 ] Clinical guidelines can be evaluated from two main aspects: utilization evaluation and evaluation of benefits and effects of guidelines along with consideration of users of these guidelines and how much they are actually being used. [ 21 ] A quantity adherence study of clinical guidelines reported that only 2.4% of specialists applied the appropriate criteria provided by the American College of Radiology (ACR). [ 15 ] Clinical guidelines and well-defined criteria in the form of evidence-based medicine are ultimately result in the benefit of patients, physicians, radiologists, and other parties and result in the steep reduction of costs while promoting quality of care services.…”

“…[ 7 ] Pursuing excellence in clinical context and academic imaging guidelines and a complex electronic environment for presenting guidelines are not the only requirements for accessing and configuring the relationship between guidelines and applicant's behavior. [ 21 ] It is evident that guidelines must be readily accessible at the time and the place where decisions are being made. For example, in an excursion of patient's bedside or during counseling, there is a need to include clinical guidelines in other information systems commonly used by physicians in a clinical environment value-based imaging which requires a culture toward continuous improvement of safety, performance, and outputs to sustain its current place in the rapidly changing and competitive field of health-care services.…”