Jaggarajamma K, Balambal R, Muniyandi M, Vasantha M, Thomas Beena, Nirupa C, Sudha G, Chandrasekaran V, Wares Fraser
Tuberculosis Research Centre (ICMR), Mayor Ramanathan Road, Chetput, Chennai 600031.
Indian J Tuberc. 2009 Oct;56(4):185-90.
Most of the persons with chest symptoms in India approach private providers (PPs) for health care. It has been observed that patients who start treatment with PPs for tuberculosis (TB) frequently switch over subsequently to the public sector. The reasons for this discontinuation and their perceptions of the TB care provided by the PPs are unknown.
To document the perceptions about PPs India's Revised National TB Control Programme (RNTCP) and the reasons for discontinuation of treatment with PPs and subsequent attendance at a public provider.
This was a cross sectional study on patients registered under TB programme during 1997 and 2005 in rural and urban areas. During this period patients who were initially diagnosed and treated for TB in a private clinic and subsequently shifted to public health facility were considered for the study. A semi-structured interview schedule was used to collect the factors related to patient's perceptions on PPs, the factors responsible for initiating treatment with PPs, reasons for discontinuing treatment with PPs, and their willingness to continue treatment from government health facilities were collected. This data was compared with data collected in 1997 before implementation of the RNTCP.
A total of 1000 and 1311 TB patients were registered during 1997 and 2005 respectively. Among them, 203 (20%) and 104 (8%) patients were identified as having been initially diagnosed and started on TB treatment by PPs and subsequently shifted to government health facilities. There were significant changes in reasons for selecting PPs between the two periods: being convenient (47% vs 10%; p < 0.001), quality care (41% vs 19%; p < 0.001), motivated by others (49% vs 19%; p < 0.001), confidentiality (19% vs 9%; p < 0.05) and known doctor (6% vs 28%; p < 0.001) respectively. Financial problems were the most common reason for discontinuation of treatment in both periods. The use of sputum test for diagnosing TB by PPs was significantly increased after RNTCP implementation.
This study suggests that slowly perceptions of patients have changed towards PPs, and RNTCP has begun to gain acceptance amongst patients in terms of convenience, confidentiality and personal care.
在印度，大多数有胸部症状的人会寻求私立医疗服务提供者（PPs）进行医疗保健。据观察，开始在私立机构接受结核病（TB）治疗的患者随后经常转而寻求公共部门的治疗。这种中断治疗的原因以及他们对私立机构提供的结核病治疗的看法尚不清楚。
记录印度修订后的国家结核病控制计划（RNTCP）对私立医疗服务提供者的看法，以及中断在私立机构治疗并随后前往公共医疗服务提供者处就诊的原因。
这是一项对1997年至2005年期间在农村和城市地区结核病项目登记患者的横断面研究。在此期间，最初在私立诊所被诊断并接受结核病治疗，随后转而前往公共卫生机构的患者被纳入研究。使用半结构化访谈提纲收集与患者对私立医疗服务提供者的看法、选择在私立机构开始治疗的因素、中断在私立机构治疗的原因以及他们继续在政府卫生机构接受治疗的意愿相关的因素。将这些数据与1997年RNTCP实施前收集的数据进行比较。
1997年和2005年分别共有1000名和1311名结核病患者登记。其中，分别有203名（20%）和104名（8%）患者被确定最初在私立机构被诊断并开始接受结核病治疗，随后转而前往政府卫生机构。两个时期选择私立机构的原因有显著变化：方便（47%对10%；p<0.001）、优质护理（41%对19%；p<0.001）、受他人影响（49%对19%；p<0.001）、保密性（19%对9%；p<0.05）和认识医生（6%对28%；p<0.001）。经济问题是两个时期中断治疗最常见的原因。RNTCP实施后，私立机构使用痰检诊断结核病的情况显著增加。
本研究表明，患者对私立医疗服务提供者的看法在逐渐改变，RNTCP在便利性、保密性和个性化护理方面开始在患者中获得认可。
