How do patients access the private sector in Chennai, India? An evaluation of delays in tuberculosis diagnosis
How do patients access the private sector in Chennai, India? An evaluation of delays in tuberculosis diagnosis
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DOI：
10.5588/ijtld.15.0423
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发表时间：
2016-04-01
影响因子：
4
通讯作者：
Dowdy, D. W.
中科院分区：
文献类型：
--
作者：
Murrison, L. Bronner;Ananthakrishnan, R.;Dowdy, D. W.
背景：印度结核病（TB）的诊断和治疗的特点是私营部门的大量参与。在印度私营部门寻求治疗的患者中，治疗延迟的特征仍然很差。目的：评估私营部门诊断的患者中结核病诊断和治疗开始的延迟，以及城市环境中的护理途径。设计：对289名连续在私营部门诊断为结核病并通过公共机构转介接受抗结核治疗的患者进行的横断面调查-结果：在212例肺结核患者中，90%的患者首先联系了正式的私人提供者，78%的患者在每位提供者平均就诊3次后由第一或第二位提供者诊断。中位总延迟时间为51天（平均68天）。咨询非正式（而不是经过正式培训的）提供者优先与总延迟的显著增加相关（绝对增加22.8天，95% CI 6.2-39.5）和长期延迟>90天的风险（aRR 2.4，95%CI 1.3-4.4）。结论：即使在钦奈正规（与非正规）私营部门寻求治疗的患者中，诊断延迟也很严重。需要采取新的战略，让私营提供者参与进来，因为他们往往是第一个接触点。
SETTING: The diagnosis and treatment of tuberculosis (TB) in India are characterized by heavy private-sector involvement. Delays in treatment remain poorly characterized among patients seeking care in the Indian private sector.OBJECTIVE: To assess delays in TB diagnosis and treatment initiation among patients diagnosed in the private sector, and pathways to care in an urban setting.DESIGN: Cross-sectional survey of 289 consecutive patients diagnosed with TB in the private sector and referred for anti-tuberculosis treatment through a public-private mix program in Chennai from January 2014 to February 2015.RESULTS: Among 212 patients with pulmonary TB, 90% first contacted a formal private provider, and 78% were diagnosed by the first or second provider seen after a median of three visits per provider. Median total delay was 51 days (mean 68). Consulting an informal (rather than formally trained) provider first was associated with significant increases in total delay (absolute increase 22.8 days, 95 %CI 6.2-39.5) and in the risk of prolonged delay >90 days (aRR 2.4, 95 %CI 1.3-4.4).CONCLUSION: Even among patients seeking care in the formal (vs. informal) private sector in Chennai, diagnostic delays are substantial. Novel strategies are required to engage private providers, who often serve as the first point of contact.