Patient and health service delay in pulmonary tuberculosis patients attending a referral hospital: a cross-sectional study.
Patient and health service delay in pulmonary tuberculosis patients attending a referral hospital: a cross-sectional study.
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DOI：
10.1186/1471-2458-5-122
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发表时间：
2005-11-24
影响因子：
4.5
通讯作者：
Harriet MK
中科院分区：
文献类型：
--
作者：
Kiwuwa MS;Charles K;Harriet MK
诊断和开始有效治疗的延误会增加结核病的发病率和死亡率以及社区传播的风险。本研究的目的是确定后来确认患有结核病的患者向第一位医疗服务提供者出现症状所需的时间（患者延迟）以及第一次医疗保健就诊和开始结核病治疗之间所需的时间（医疗服务延迟）。分析了与这些“延迟”相关的因素。 2002 年 1 月至 5 月，坎帕拉穆拉戈国家转诊医院对 231 名新诊断的涂阳结核病患者进行了一项横断面调查。使用包括多变量 Logistic 回归在内的 95% 置信区间 (CI) 的比值比，评估了社会人口、生活方式和就医因素与患者延误（>2 周）和医疗服务延误（>4 周）的关系。治疗开始的中位总延迟时间为 12 周。作为初次接触者，患者经常去药店或药房（39.4%）和私人诊所（36.8%），而不是政府卫生单位（14%）。确定了“患者延误”的几个独立预测因素：住院（比值比 [0R] = 0.32；95% CI：0.12–0.80）、每日饮酒量（OR = 3.7；CI：1.57–9.76）、自给农业（OR = 4.70；CI：1.67–13.22）以及认为吸烟是结核病的一个原因（OR = 5.54；置信区间：2.26-13.58）。 “医疗服务延误”的独立预测因素为：每月 >2 次就医（OR = 2.74；CI：1.10–6.83），以及结核病相关症状的医疗支出 >29 美元（OR = 3.88；CI：1.19–12.62）。结核病耻辱感和教育状况与这两种形式的延误均无关。转诊中心的结核病诊断延迟时间较长，其中很大一部分是卫生服务延迟。对公众进行更具体和有效的结核病健康教育并寻求适当的医疗咨询可能会改善病例发现。某些特定群体需要进一步关注。应以酗酒者和自给农民为目标，提高结核病治疗的可及性。应对卫生服务提供者进行有关结核病管理程序的继续医学教育，并提高结核病控制服务的能力。
Delays in diagnosis and initiation of effective treatment increase morbidity and mortality from tuberculosis as well as the risk of transmission in the community. The aim of this study was to determine the time taken for patients later confirmed as having TB to present with symptoms to the first health provider (patient delay) and the time taken between the first health care visit and initiation of tuberculosis treatment (health service delay). Factors relating to these 'delays' were analyzed. A cross-sectional survey, of 231 newly diagnosed smear-positive tuberculosis patients was conducted in Mulago National referral Hospital Kampala, from January to May 2002. Socio-demographic, lifestyle and health seeking factors were evaluated for their association with patient delay (>2 weeks) and health service delay (>4 weeks), using odds ratios with 95% confidence intervals (CI) including multivariate logistic regression. The median total delay to treatment initiation was 12 weeks. Patients often presented to drug shops or pharmacies (39.4%) and private clinics (36.8%) more commonly than government health units (14%) as initial contacts. Several independent predictors of 'patient delay' were identified: being hospitalized (odds ratio [0R] = 0.32; 95% CI: 0.12–0.80), daily alcohol consumption (OR = 3.7; CI: 1.57–9.76), subsistence farming (OR = 4.70; CI: 1.67–13.22), and perception of smoking as a cause of TB (OR = 5.54; CI: 2.26–13.58). Independent predictors of 'health service delay' were: >2 health seeking encounters per month (OR = 2.74; CI: 1.10–6.83), and medical expenditure on TB related symptoms >29 US dollars (OR = 3.88; CI: 1.19–12.62). Perceived TB stigma and education status was not associated with either form of delay. Delay in diagnosis of TB is prolonged at the referral centre with a significant proportion of Health service delay. More specific and effective health education of the general public on tuberculosis and seeking of appropriate medical consultation is likely to improve case detection. Certain specific groups require further attention. Alcoholics and subsistence farmers should be targeted to improve accessibility to TB treatment. Continuing medical education about TB management procedures for health providers and improvement in the capacity of TB control services should be undertaken.
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影响因子：
3.3
作者：
Auer, C;Sarol, J;Weiss, M
通讯作者：
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