Kelkar-Khambete A, Kielmann K, Pawar S, Porter J, Inamdar V, Datye A, Rangan S
Maharashtra Association of Anthropological Sciences, Centre for Health Research and Development, Pune, India.
Int J Tuberc Lung Dis. 2008 Jan;12(1):87-92.
Pune District, Maharashtra State, India.
To examine delays experienced by patients in accessing directly observed treatment.
Data were collected from 117 new sputum-positive patients using a semi-structured interview schedule.
Patient delays as well as diagnostic and treatment delays, which reflect the performance of a National TB Programme, were minimal. Provider delays, however, contributed significantly to delayed entry into India's Revised National TB Control Programme (RNTCP). Patients had to resort to multiple contacts with providers due to limitations of these providers in diagnosing or directing patients to the RNTCP. Patients who consulted a private provider participating in the public-private mix (PPM) were more likely to be suspected (OR 2.63, 90% CI 1.04-6.64) and referred (OR 6.8, 95%CI 2.08-22.21) to the RNTCP. Once the patients entered the RNTCP, the response of the system was rapid, with diagnosis offered and treatment initiated within on average 7 days.
Interventions aimed at providers to encourage early suspicion and referral to the RNTCP, such as the PPM, are more important in improving patient access to TB care than those focusing on reducing patient delays.
印度马哈拉施特拉邦浦那地区。
调查患者在接受直接观察治疗时所经历的延误情况。
采用半结构化访谈提纲，对117名新的痰涂片阳性患者进行数据收集。
反映国家结核病规划绩效的患者延误以及诊断和治疗延误极少。然而，提供者延误是导致患者延迟进入印度修订的国家结核病控制规划（RNTCP）的重要因素。由于这些提供者在诊断或将患者转诊至RNTCP方面存在局限性，患者不得不与他们多次接触。咨询参与公私混合（PPM）的私立提供者的患者更有可能被怀疑（比值比2.63，90%可信区间1.04 - 6.64）并被转诊至RNTCP（比值比6.8，95%可信区间2.08 - 22.21）。一旦患者进入RNTCP，系统反应迅速，平均在7天内提供诊断并开始治疗。
旨在促使提供者尽早怀疑并转诊至RNTCP的干预措施，如公私混合，在改善患者获得结核病治疗方面比那些侧重于减少患者延误的措施更为重要。
