Patient and provider delay in tuberculosis suspects from communities with a high HIV prevalence in South Africa: a cross-sectional study.
Patient and provider delay in tuberculosis suspects from communities with a high HIV prevalence in South Africa: a cross-sectional study.
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DOI：
10.1186/1471-2334-8-72
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发表时间：
2008-05-25
影响因子：
3.7
通讯作者：
Maartens, Gary
中科院分区：
文献类型：
--
作者：
Meintjes, Graeme;Schoeman, Hennie;Morroni, Chelsea;Wilson, Douglas;Maartens, Gary
结核病诊断的延误导致发病率和死亡率过高，特别是在艾滋病毒感染者中。这项研究是在南非开普敦的一家二级医院进行的，该医院为艾滋病毒高发社区提供服务。目的是描述需要住院的疑似结核病患者在诊断结核病方面的患者和提供者延误，并确定这种延误的危险因素及其后果。进行了横断面研究。使用结构化问卷对疑似结核病的住院患者进行访谈，以评估其症状史和求医行为。有关结核病诊断和结果的数据来自医疗记录。使用学生t检验（均值）、卡方检验（比例）和Wilcoxon秩和检验（中位数）描述双变量关联。多元分析采用线性回归模型。125名患者接受了访谈。其中104例被诊断为结核病，并将其纳入分析。接受检测的83人中有70人（84%）感染了艾滋病毒。提供者延迟（中位数= 30天，四分位间距(IQR) = 10.3-60）是患者延迟（中位数= 14天，IQR = 7-30）的两倍。患者在转诊前与正规卫生保健服务机构的接触中位数为3次。与患者延误时间较长的独立相关因素是男性、咳嗽和首次到公共部门诊所就诊（与私人全科医生相比）。患者延迟≥14天与转移到结核病医院的需求增加相关。提供者延迟≥30天与死亡率增加相关。结核病诊断的延误更多地归因于医生而不是患者的延误，而且医生的延误与死亡率的增加有关。在这种情况下，需要制定和评估在初级保健中加快结核病诊断的干预措施。
Delay in the diagnosis of tuberculosis (TB) results in excess morbidity and mortality, particularly among HIV-infected individuals. This study was conducted at a secondary level hospital serving communities with a high HIV prevalence in Cape Town, South Africa. The aim was to describe patient and provider delay in the diagnosis of TB in patients with suspected TB requiring admission, and to determine the risk factors for this delay and the consequences. A cross-sectional study was conducted. Patients admitted who were TB suspects were interviewed using a structured questionnaire to assess history of their symptoms and health seeking behaviour. Data regarding TB diagnosis and outcome were obtained from the medical records. Bivariate associations were described using student's T-tests (for means), chi-square tests (for proportions), and Wilcoxon rank-sum tests (for medians). Linear regression models were used for multivariate analysis. One hundred twenty-five (125) patients were interviewed. In 104 TB was diagnosed and these were included in the analysis. Seventy of 83 (84%) tested were HIV-infected. Provider delay (median = 30 days, interquartile range (IQR) = 10.3–60) was double that of patient delay (median = 14 days, IQR = 7–30). Patients had a median of 3 contacts with formal health care services before referral. Factors independently associated with longer patient delay were male gender, cough and first health care visit being to public sector clinic (compared with private general practitioner). Patient delay ≥ 14 days was associated with increased need for transfer to a TB hospital. Provider delay ≥ 30 days was associated with increased mortality. Delay in TB diagnosis was more attributable to provider than patient delay, and provider delay was associated with increased mortality. Interventions to expedite TB diagnosis in primary care need to be developed and evaluated in this setting.
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