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

Date Published: March 20, 2019

Publisher: Public Library of Science

Author(s): Carmelita E. Ventura-Alfaro, Leticia Ávila-Burgos, Gabriela Torres-Mejía, Karen Anne Grimmer.


To 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).

Based 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.

Adherence 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). The FPGC strategy increased the adherence of physicians to the Medical-Care Guidelines for Malignant Breast Tumors in Mexico.

Partial Text

The most prevalent type of oncological disease in women, breast cancer (BC), has become a worldwide public health concern. Of the 20,000 new cases reported in Mexico each year, one quarter are fatal [1]. BC treatment has improved considerably over time; however, inadequate adherence of medical personnel to the Medical-Care Guidelines for Malignant Breast Tumors established by the Mexican Social Protection System in Health (SPSS by its Spanish initials) poses a challenge to the Mexican Health-Care System, characterized by limited resources and burdened by the inordinately high costs of BC diagnosis and treatment [2, 3].

We recruited a total of 479 women between the ages of 29 and 99 years: 212 had been treated for BC before and 267 after their hospitals were accredited to receive FPGC financing. Their mean ages were 54.3 years (SD 12.1 years) and 56.2 years (SD 13.6 years), respectively. As shown in Table 1, the two groups exhibited similar socio-demographic characteristics: 28% of participants had no schooling and slightly over half were married. The clinical stages of their condition were distributed similarly as well, with the majority of patients (60%) in stages IIB and III. In comparing the levels of adherence of physicians to the SPSS Guidelines before and after 2007, the former came out lower (p<0.001). The proportion of women who received chemotherapy (p = 0.012), trastuzumab medication (p<0.001) and estrogen (p<0.001) or Her2/neu (p<0.001) receptor tests was greater among those treated after FPGC accreditation. Our results show that adherence of physicians to the Mexican Medical-Care Guidelines for Malignant Breast Tumors increased after accredited hospitals were provided with financing from the Catastrophic Health Expenditure Fund (FPGC by its Spanish initials) as a strategy established by law in 2007 in order to offer free treatment to women with breast cancer (BC). Analysis also indicated that this increase was higher when women were treated in early rather than in late clinical stages. After the implementation of FPGC accreditation, the increase in adherence was most pronounced in the prescription of expensive treatments such as trastuzumab versus other treatments. Our findings suggest that the accreditation of hospitals to receive FPGC financing reduced the economic barriers for BC treatment, improving medical care in certain treatment areas such as chemotherapy and trastuzumab medication, as well as in estrogen and Her2/neu receptor testing, with variance observed among hospitals. Results from this study suggest that subsidizing the cost of treatment for BC and other diseases at accredited hospitals boosts the adherence of physicians to medical-care guidelines. However, it is essential to streamline the processes for the transference of funds and to implement other innovative strategies in pursuit of greater levels of adherence on the part of physicians. This will contribute to the delivery of timely and efficient medical care according to the guidelines established by the Mexican Health-Care System and result in a higher quality of life and lower mortality rates among women with BC.   Source:


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