Why do symptomatic patients delay obtaining care for tuberculosis?
Why do symptomatic patients delay obtaining care for tuberculosis?
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DOI：
10.1164/ajrccm.157.4.9709071
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发表时间：
1998-04-01
影响因子：
24.7
通讯作者：
Gelberg, L
中科院分区：
文献类型：
--
作者：
Asch, S;Leake, B;Gelberg, L
结核病（TB）的复苏与高风险人群获得护理的机会恶化同时发生。我们试图确定是什么感知的获取障碍延迟了有症状的结核病患者获得治疗。为了做到这一点，我们在加州的洛杉矶县进行了一项调查，使用了县结核病控制机构确认的活动性结核病患者的连续样本。在研究中使用的措施是自我报告的延迟寻求治疗超过60天的症状发作，一段时间足以导致皮肤测试转换暴露的接触，和自我报告的访问障碍。县结核病登记处提供了补充临床数据。我们发现，在248名有症状的受访者中，有五分之一（应答率：60%）延迟获得护理> 60天（平均值= 74天，SD = 216天）。在延迟期间，患者平均接触8次。与其他样本比较，延迟在失业人士中较为普遍（25%对14%），关注成本（27%对14%），预计等候时间延长（26%对14%），相信他们可以治疗自己（31%对14%），预计难以获得预约（28%对16%），不确定在哪里得到照顾（33%对16%），害怕移民当局（47%对18%）（p < 0.05）。Logistic回归分析显示，不确定在哪里得到照顾，失业，并在自我治疗的疗效的信念独立预测延迟> 60天。通过胸部X光片、痰涂片和症状测量的疾病严重程度对延迟的影响很小。我们的结论是，因为访问变量，如缺乏就业和知识，在哪里获得护理更密切相关的临床显着的延迟比疾病的严重程度，这些结果引起关注的公平获得结核病患者的护理。研究结果表明，改善高危人群的服务可获得性可能会大大减少结核病患者获得治疗的延误，从而可能限制疾病的传播。
The resurgence of tuberculosis (TB) has coincided with deteriorating access to care for high-risk populations. We sought to determine what perceived access barriers delayed symptomatic TB patients from obtaining care. In order to do this, we conducted a survey in Los Angeles County, California, using a consecutive sample of patients with active TB as confirmed by the county TB control authority. The measures used in the study were a self-reported delay in seeking care of more than 60 d from symptom onset, a period sufficient to cause skin-test conversion in exposed contacts, and self-reported access barriers. The county TB registry provided supplementary clinical data. We found that one in five of the 248 symptomatic respondents (response rate: 60%) delayed obtaining care for > 60 d (mean = 74 d, SD = 216 d). During the delay, patients exposed an average of eight contacts. As compared with the rest of the sample, delay was more common in those who were unemployed (25% versus 14%), concerned about cost (27% versus 14%), anticipated prolonged waiting-room time (26% versus 14%), believed they could treat themselves (31% versus 14%), anticipated difficulty in getting an appointment (28% versus 16%), were uncertain about where to get care (33% versus 16%), and feared immigration authorities (47% versus 18%) (p < 0.05). Logistic regression revealed that uncertainty about where to get care, unemployment, and belief in the efficacy of self-treatment independently predicted delay > 60 d. Illness severity as measured by chest radiography, sputum smears, and symptoms had little impact on delay. We conclude that because access variables such as lack of employment and knowledge about where to obtain care were more closely associated with clinically significant delay than was severity of illness, these results raise concerns about the equity of access to care among TB patients. The results suggest that improving the availability of services for high-risk groups may substantially reduce TB patients' delay in obtaining care, and thus may limit the spread of the disease.