Selvam Jerard M, Wares F, Perumal M, Gopi P G, Sudha G, Chandrasekaran V, Santha T
Office of the World Health Organization Representative to India, New Delhi.
Int J Tuberc Lung Dis. 2007 Feb;11(2):161-7.
Although case detection is above 70% in Tamil Nadu after DOTS implementation, an assessment of the timeliness of patient diagnosis and treatment is still needed.
To study the health-seeking behaviour of new smear-positive pulmonary tuberculosis (PTB) patients treated at government facilities.
New smear-positive patients diagnosed and treated between January and March 2003 in government facilities of randomly selected blocks in Tamil Nadu were interviewed using a semi-structured interview schedule.
Of 601 patients interviewed, 65% contacted a provider within 28 days. The first contact was governmental for 47% and non-governmental for 53%. Median total, patient and provider delays were respectively 62, 28 and 28 days; provider delay was 9 days with government and 50 with private provider. In multivariate analysis, patient delay was significantly associated with smoking (P < 0.001) and mode of travel (P < 0.01), and provider delay with first consultation with a private provider (P < 0.001) and distance > 5 km from the health facility (P < 0.01). Twenty-five per cent of patients took more than two actions before diagnosis.
Community awareness of TB needs to be increased. Greater private sector involvement in the Revised National Tuberculosis Control Programme is essential to reduce provider delay. Referral and sputum transportation to the diagnostic facility should be given priority.
尽管在泰米尔纳德邦实施直接观察短程化疗（DOTS）后病例发现率超过70%，但仍需要对患者诊断和治疗的及时性进行评估。
研究在政府医疗机构接受治疗的新涂片阳性肺结核（PTB）患者的就医行为。
采用半结构化访谈提纲，对2003年1月至3月在泰米尔纳德邦随机选取街区的政府医疗机构诊断和治疗的新涂片阳性患者进行访谈。
在接受访谈的601名患者中，65%在28天内联系了医疗服务提供者。首次联系政府机构的占47%，联系非政府机构的占53%。总延迟、患者延迟和医疗服务提供者延迟的中位数分别为62天、28天和28天；政府机构医疗服务提供者的延迟为9天，私立医疗服务提供者的延迟为50天。多变量分析显示，患者延迟与吸烟（P < 0.001）和出行方式（P < 0.01）显著相关，医疗服务提供者延迟与首次咨询私立医疗服务提供者（P < 0.001）以及距离医疗机构>5公里（P < 0.01）显著相关。25%的患者在诊断前采取了两项以上行动。
需要提高社区对结核病的认识。私营部门更多地参与修订后的国家结核病控制规划对于减少医疗服务提供者延迟至关重要。应优先考虑将患者转诊并将痰液运送到诊断机构。
