埃塞俄比亚肺结核患者结核病诊断延误的成本影响。
Cost implications of delays to tuberculosis diagnosis among pulmonary tuberculosis patients in Ethiopia.
机构信息
Nuffield Centre for International Health and Development, Institute of Health Sciences, University of Leeds, Leeds, UK.
出版信息
BMC Public Health. 2010 Mar 30;10:173. doi: 10.1186/1471-2458-10-173.
BACKGROUND
Delays seeking care worsen the burden of tuberculosis and cost of care for patients, families and the public health system. This study investigates costs of tuberculosis diagnosis incurred by patients, escorts and the public health system in 10 districts of Ethiopia.
METHODS
New pulmonary tuberculosis patients > or = 15 years old were interviewed regarding their health care seeking behaviour at the time of diagnosis. Using a structured questionnaire patients were interviewed about the duration of delay at alternative care providers and the public health system prior to diagnosis. Costs incurred by patients, escorts and the public health system were quantified through patient interview and review of medical records.
RESULTS
Interviews were held with 537 (58%) smear positive patients and 387 (42%) smear negative pulmonary patients. Of these, 413 (45%) were female; 451 (49%) were rural residents; and the median age was 34 years. The mean (median) days elapsed for consultation at alternative care providers and public health facilities prior to tuberculosis diagnosis was 5 days (0 days) and 3 (3 days) respectively. The total median cost incurred from first consultation to diagnosis was $27 per patient (mean = $59). The median costs per patient incurred by patient, escort and the public health system were $16 (mean = $29), $3 (mean = $23) and $3 (mean = $7) respectively. The total cost per patient diagnosed was higher for women, rural residents; those who received government food for work support, patients with smear negative pulmonary tuberculosis and patients who were not screened for TB in at least one district diagnostic centers.
CONCLUSIONS
The costs of tuberculosis diagnosis incurred by patients and escorts represent a significant portion of their monthly income. The costs arising from time lost in seeking care comprised a major portion of the total cost of diagnosis, and may worsen the economic position of patients and their families. Getting treatment from alternative sources and low index of suspicion public health providers were key problems contributing to increased cost of tuberculosis diagnosis. Thus, the institution of effective systems of referral, ensuring screening of suspects across the district public health system and the involvement of alternative care providers in district tuberculosis control can reduce delays and the financial burden to patients and escorts.
背景
结核病患者延迟寻求医疗服务会加重患者、家庭和公共卫生系统的负担，并且增加治疗成本。本研究旨在调查埃塞俄比亚 10 个地区结核病患者、陪护者和公共卫生系统在结核病诊断方面的费用。
方法
对年龄≥15 岁的新发肺结核患者进行访谈，了解其诊断时的就医行为。通过结构化问卷，了解患者在各级医疗机构的就诊时间和延迟时间。通过患者访谈和病历审查，对患者、陪护者和公共卫生系统所产生的费用进行量化。
结果
共访谈了 537 例（58%）涂阳患者和 387 例（42%）涂阴肺结核患者。其中，413 例（45%）为女性，451 例（49%）为农村居民，中位年龄为 34 岁。在获得结核病诊断之前，患者在其他医疗机构和公共卫生机构的平均（中位数）就诊天数分别为 5 天（0 天）和 3 天（3 天）。从首次就诊到诊断的总中位数费用为每位患者 27 美元（平均 59 美元）。每位患者的平均个人费用、陪护者费用和公共卫生系统费用分别为 16 美元（平均 29 美元）、3 美元（平均 23 美元）和 3 美元（平均 7 美元）。女性、农村居民、接受政府以工代赈食物援助、涂阴肺结核患者和未在至少一个地区诊断中心进行结核病筛查的患者的诊断费用更高。
结论
患者和陪护者的结核病诊断费用占其月收入的很大一部分。因就医而损失的时间所产生的费用占诊断总费用的很大一部分，可能会使患者及其家庭的经济状况恶化。从其他渠道获得治疗以及公共卫生服务提供者的低检出率是导致结核病诊断费用增加的主要问题。因此，建立有效的转诊系统、确保在整个地区公共卫生系统中筛查疑似患者以及让其他医疗机构参与地区结核病控制，可以减少患者和陪护者的延误和经济负担。
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