VAŽNOST INDIVIDUALNOG PRISTUPA U UNAPRJEĐENJU PROVEDBE NACIONALNOG PROGRAMA RANOG OTKRIVANJA RAKA DEBELOG CRIJEVA ; IMPORTANCE OF INDIVIDUAL APPROACH IN IMPROVEMENT OF NATIONAL COLORECTAL CANCER SCREENING PROGRAM PERFORMANCE
Uvod: U Hrvatskoj, smrtnost od raka debelog crijeva (RDC) viša je u usporedbi s prosjekom država članica Europske unije (EU). U Hrvatskoj se od 2007. godine provodi Nacionalni program ranog otkrivanja raka debelog crijeva (NPRDC), s ciljem smanjenja smrtnosti od RDC, otkrivanja bolesti u ranijem stadiju, poboljšanja mogućnosti liječenja i kvalitete života oboljelih. Prema Europskim smjernicama za osiguranje kvalitete probira i dijagnostike, prihvatljiv odaziv u NPRDC je najmanje 45%, koji u Hrvatskoj do sada nije postignut. Cilj: Cilj ovoga rada je procijeniti učinak javno-zdravstvene intervencije kućnog posjeta studenata medicine osobama uključenim u NPRDC na odaziv na test na okultno krvarenje (Hemocult test). Metode: Uzorak za intervenciju činili su sve žene i muškarci uključeni u NPRDC iz dva naselja (Vetovo i Kaptol) u Požeško-slavonskoj županiji. U Vetovu je provedena intervencija (N=338), a osobe iz Kaptola uzete su kao kontrolna skupina (N=417). Intervenciju kućnim posjetima su provodili studenti završne godine studija medicine uz koordinaciju Zavoda za javno zdravstvo Požeško-slavonske županije. Osobama koje su pristale sudjelovati u intervenciji objašnjen je razlog dolaska, provedeno je informiranje o važnosti sudjelovanja u NP kroz anketom vođeni razgovor te im je ponuđen Hemocult test uz detaljne upute o primjeni. Prikupljeni podatci obrađeni su u programu Microsoft Office Excel metodama deskriptivne statistike. Rezultati: Prije provedbe intervencije u Vetovu je odaziv u sklopu NPRDC (osobe koje su dale suglasnost za Hemocult test/osobe pozvane u NPRDC) bio 14,4%, a u Kaptolu 18,6%; χ2 (1)=1,177, p>0,05. Nakon provedbe intervencije, odaziv u Vetovu bio je 45,7%, a u Kaptolu 21%; χ2 (1)=29,986, p0,05. Nakon provedbe intervencije, odaziv u Vetovu bio je 24,7%, a u Kaptolu 15,1% (bez intervencije); χ2 (1)=6,317, p=0,012. Zaključak: U naselju gdje je provedena intervencija u obliku kućnih posjeta, postignut je značajno veći obuhvat neodazvanih osoba na Hemocult test, u usporedbi sa susjednim naseljem sličnih karakteristika, gdje su provedene uobičajeni postupci pozivanja osoba predviđeni protokolom u sklopu NPRDC. Rezultati rada ukazuju na važnost individualnog pristupa u javno-zdravstvenoj praksi u unapređenju provedbe NPRDC. ; Introduction: Colorectal cancer (CC) mortality in Croatia is higher than average of European Union (EU) member states. From 2007, National Colorectal Cancer Screening Program (NPCC) has been conducted in Croatia, with aim of reducing CC mortality, detecting illness in early stage, better treatment options and life quality improvement. According to European Guidelines for Quality Assurance of Screening and Diagnosis of CC, acceptable response rate to screening is at least 45%, which hasn't been reached in Croatia so far. Aim: The aim of this study was to evaluate impact of public health intervention in form of home visits made by medical students, on Hemoccult test to persons included in NPCC. Methods: The sample for intervention was persons included in NPCC from two settlements, Vetovo and Kaptol in Požega-Slavonia County. Intervention was performed in Vetovo (N=338), while participants from Kaptol served as control group (N=417). Home visits were conducted by final year of study medical students in coordination with Public Health Institute of Požega-Slavonia County. Students explained reason for visit, importance of participation in NP to persons who agreed to participate in intervention, using standardized survey interview, and offered Hemocult test with detailed explanation of how to use it. The data were processed in Microsoft Office Excel using descriptive statistic methods. Results: Before intervention, response rate within NPCC (persons who signed consent for Hemocult test/persons invited to NPCC) in Vetovo was 14.4% and 18.6% in Kaptol; χ2 (1)=1.177, p>0.05. After intervention, response rate in Vetovo was 45.7% and in Kaptol 21.0%; χ2 (1)=29.986, p0.05. After intervention, response rate to Hemocult test in Vetovo was 24.7%, and 15.1% in Kaptol (without intervention); χ2 (1)=6.317, p=0.012. Conclusion: In settlement where home visits intervention was performed, a significantly higher response rates on Hemocult test was achieved, compared with neighbouring settlement of similar characteristics, where usual NPCC protocol was followed. Results of the study implied importance of individual approach in public health practice in improvement of NPCC performance.