Use of standardised patients to assess gender differences in quality of tuberculosis care in urban India: a two-city, cross-sectional study
Use of standardised patients to assess gender differences in quality of tuberculosis care in urban India: a two-city, cross-sectional study
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DOI：
10.1016/s2214-109x(19)30031-2
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发表时间：
2019-05-01
影响因子：
34.3
通讯作者：
Pai, Madhukar
中科院分区：
文献类型：
--
作者：
Daniels, Benjamin;Kwan, Ada;Pai, Madhukar
在印度，男性比女性更容易患活动性结核病，但被诊断和通知国家结核病规划的可能性较小。我们使用的数据从标准化的病人访问，以评估这些性别差异是否发生，因为供应商practice.Methods我们发送标准化的病人（人从当地人口中招募，并训练描绘脚本的医疗条件的卫生保健提供者），目前四个结核病病例的情况下，私人医疗保健提供者在城市的孟买和巴特那。抽样和加权允许城市代表解释。由于标准化患者是由对本研究不知情的现场团队分配给提供者的，因此我们进行了平衡和安慰剂回归测试，以确认标准化患者是按性别随机分配的。然后，通过使用线性和逻辑回归，我们评估了正确的情况下管理，我们的主要成果，和其他方面的护理标准化患者gender.Findings之间的2014年11月21日，2015年8月21日，2602临床互动在1203私人设施完成了24个标准化患者（16名男性，8名女性）。我们发现标准化的患者被随机分配给提供者。我们发现患者性别在正确管理方面没有差异（比值比1.05; 95%CI 0.76-1. 45岁; p=0.77），在任何情况下，设置，提供者性别，或提供者的资格没有性别差异。解释护理质量的系统差异不太可能是印度城市私营部门结核病通知中观察到的男性代表性不足的原因。版权所有（C）2019作者。爱思唯尔有限公司出版
Background In India, men are more likely than women to have active tuberculosis but are less likely to be diagnosed and notified to national tuberculosis programmes. We used data from standardised patient visits to assess whether these gender differences occur because of provider practice.Methods We sent standardised patients (people recruited from local populations and trained to portray a scripted medical condition to health-care providers) to present four tuberculosis case scenarios to private health-care providers in the cities of Mumbai and Patna. Sampling and weighting allowed for city representative interpretation. Because standardised patients were assigned to providers by a field team blinded to this study, we did balance and placebo regression tests to confirm standardised patients were assigned by gender as good as randomly. Then, by use of linear and logistic regression, we assessed correct case management, our primary outcome, and other dimensions of care by standardised patient gender.Findings Between Nov 21, 2014, and Aug 21, 2015, 2602 clinical interactions at 1203 private facilities were completed by 24 standardised patients (16 men, eight women). We found standardised patients were assigned to providers as good as randomly. We found no differences in correct management by patient gender (odds ratio 1.05; 95% CI 0.76-1. 45; p=0.77) and no differences across gender within any case scenario, setting, provider gender, or provider qualification.interpretation Systematic differences in quality of care are unlikely to be a cause of the observed under-representation of men in tuberculosis notifications in the private sector in urban India. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd.