Origin-destination flows in chemotherapy for breast cancer in Brazil: implications for pharmaceutical servicesThis study maps and analyzes patient flows for breast cancer chemotherapy in order to identify the potential implications for organization of pharmaceutical services in the cancer care network. An ecological study design sought to correlate the place of residence with place of care for breast cancer patients. All chemotherapy procedures financed by Brazil’s Unified Health System (SUS) and performed from January to December 2013 were included. Flows were mapped using TerraView® software. A total of 1 347 803 outpatient chemotherapy procedures were delivered by 243 cancer care units located in 156 municipalities. Seventeen cities concentrated approximately 50.0 % of the procedures. A total of 8 538 origin-destination flows were generated and 49.2% of procedures were performed in services located outside the municipality in which the patient resided. Context challenges, related to inequality of access to chemotherapy and hindrances in planning and management of pharmaceutical services, were discussed.
Pharmaceutical services; Healthcare delivery; Breast cancer; Spatial analysis; Health services accessibility
a Local link – when origin and destination coincide; b Direct upward hierarchical flows – follow the network structure and the link goes to a node at a higher hierarchical level; c Short-circuit upward hierarchical flows – follow the network structure and the link goes to a node at a higher hierarchical level but skips the closest hierarchical level; d Direct downward hierarchical flows – follow the network structure and the link goes to a node at a lower hierarchical level; e Short-circuit downward hierarchical flows – follow the network structure and the link goes to a node at a lower hierarchical level but skips the closest hierarchical level; f Upward cross-cutting flows between networks – when the link occurs between networks, going to a node at a higher hierarchical level; g Downward cross-cutting flows between networks – when the link occurs between networks, going to a node at a lower hierarchical level; h Horizontal cross-cutting flows between networks – when the link occurs between different networks and connects nodes at the same hierarchical level; i Horizontal cross-cutting flows in the same network – when the link is internal to the network and connects nodes at the same hierarchical level.