Sarmiento K, Hirsch-Moverman Y, Colson P W, El-Sadr W
Charles P Felton National Tuberculosis Center, Kountz Pavilion at Harlem Hospital Center, 15 West 136th Street, 6th Floor, New York, NY 10037, USA.
Int J Tuberc Lung Dis. 2006 Oct;10(10):1140-5.
Harlem Hospital Directly Observed Therapy (DOT) Program, New York City.
To identify various pathways to tuberculosis (TB) diagnosis, and determine time to diagnosis and reasons for delay, to ensure rapid diagnosis of TB and prompt initiation of appropriate treatment.
Cross-sectional survey of the help-seeking behavior of TB patients within 2 months of their enrollment into DOT from May 2001 to December 2004.
The average total delay between symptom onset and a patient's diagnosis of TB was 18 weeks among 39 patients. The average delay to diagnosis attributed to patient delay and health care system delay were 10.5 and 7.5 weeks, respectively. Patients visited on average 1.6 sources of care prior to receiving a TB diagnosis. Foreign-born patients in particular were found to have more complex paths to diagnosis. The most common reason for delaying seeking care reported by patients was that they didn't think it was serious' (29.1%).
There was a substantial time interval between the onset of symptoms and TB diagnosis due to both patient and health care system delay. Foreign-born status, economic and social factors, and missed opportunities for diagnosis by the health care system played important roles in delaying TB diagnoses for the marginalized patients in this study.
纽约市哈莱姆医院直接观察治疗（DOT）项目。
确定结核病（TB）诊断的各种途径，确定诊断时间及延误原因，以确保结核病的快速诊断并及时开始适当治疗。
对2001年5月至2004年12月期间纳入DOT的结核病患者在入组后2个月内的就医行为进行横断面调查。
39例患者中，从症状出现到结核病诊断的平均总延误时间为18周。归因于患者延误和医疗系统延误的平均诊断延误分别为10.5周和7.5周。患者在获得结核病诊断之前平均就诊1.6个医疗机构。尤其发现出生在国外的患者诊断途径更为复杂。患者报告的延迟就医最常见原因是“他们认为病情不严重”（29.1%）。
由于患者和医疗系统的延误，症状出现与结核病诊断之间存在相当长的时间间隔。在本研究中，出生在国外的身份、经济和社会因素以及医疗系统错过的诊断机会在边缘化患者的结核病诊断延误中起重要作用。
