Tuberculosis Management by Private Practitioners in Mumbai, India: Has Anything Changed in Two Decades?
Tuberculosis Management by Private Practitioners in Mumbai, India: Has Anything Changed in Two Decades?
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DOI：
10.1371/journal.pone.0012023
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发表时间：
2010-08-09
期刊：
影响因子：
3.7
通讯作者：
Uplekar, Mukund W.
中科院分区：
文献类型：
--
作者：
Udwadia, Zarir F.;Pinto, Lancelot M.;Uplekar, Mukund W.
背景：印度，孟买。20年前在孟买进行的一项研究揭示了私人医生不适当的结核病管理做法的程度。多年来，印度的国家结核病规划在结核病控制方面取得了重大进展。努力让私人执业医生也取得了一些成功的记录公私混合initiatives in place.Objective：To study prescription practices of private practitioners in the treatment of tuberculosis，two-decades after a similar study carried out in the same geographical area revealed desperate results.Methods：调查问卷管理执业全科医生参加继续医学教育programme.Results：当地结核病规划从未接触或指导过参与的从业人员。在106名受访者中，只有6人写了正确的药物处方。106名医生开了63种不同的药物治疗方案。存在使用更多药物进行更长时间过度治疗的趋势。只有3的106名受访者可以写一个适当的处方治疗耐多药tube.Conclusions：绝大多数的私人执业医生无法提供正确的处方治疗结核病，而不是接触的国家结核病规划，多年来似乎没有什么变化。如果私人诊所对结核病患者的不当管理继续有增无减，通过公共部门卫生服务控制结核病的战略将收效甚微。大规模实施公私混合办法应是该方案的最高优先事项。忽视私营部门可能会加剧耐多药和广泛耐药结核病的流行。
Setting: Mumbai, India. A study conducted in Mumbai two decades ago revealed the extent of inappropriate tuberculosis (TB) management practices of private practitioners. Over the years, India's national TB programme has made significant progress in TB control. Efforts to engage private practitioners have also been made with several successful documented public-private mix initiatives in place.Objective: To study prescribing practices of private practitioners in the treatment of tuberculosis, two decades after a similar study conducted in the same geographical area revealed dismal results.Methods: Survey questionnaire administered to practicing general practitioners attending a continuing medical education programme.Results: The participating practitioners had never been approached or oriented by the local TB programme. Only 6 of the 106 respondents wrote a prescription with a correct drug regimen. 106 doctors prescribed 63 different drug regimens. There was tendency to over treat with more drugs for longer durations. Only 3 of the 106 respondents could write an appropriate prescription for treatment of multidrug-resistant TB.Conclusions: With a vast majority of private practitioners unable to provide a correct prescription for treating TB and not approached by the national TB programme, little seems to have changed over the years. Strategies to control TB through public sector health services will have little impact if inappropriate management of TB patients in private clinics continues unabated. Large scale implementation of public-private mix approaches should be a top priority for the programme. Ignoring the private sector could worsen the epidemic of multidrug-resistant and extensively drug-resistant forms of TB.