Department of Pulmonary Medicine, P.D. Hinduja National Hospital and Medical Research Centre, Mahim, Mumbai.
BMC Public Health. 2010 Jun 22;10:357. doi: 10.1186/1471-2458-10-357.
India accounts for one-fifth of the global incident cases of tuberculosis(TB). The country presently has the world's largest directly observed treatment, short course (DOTS) programme, that has shown impressive results and covers almost 100% of the billion-plus Indian population. Despite such a successful programme, the majority of Indian patients with tuberculosis prefer private healthcare, although repeated audits of this sector have shown the quality to be poor. We aimed to ascertain the level of awareness and knowledge of private patients with tuberculosis attending our clinic at a tertiary private healthcare institute with regards to the DOTS programme, understanding the reasons behind their preference for private healthcare, and evaluating their perceptions and reasons for accepting or failing to accept directly observed therapy as a treatment option.
A structured interview schedule was administered to private patients with tuberculosis at the P.D. Hinduja Hospital and Medical Research Centre, Mumbai, India between January 2006 to November 2007.
Only 30 of 200 patients (15%) were aware of the DOTS programme. After being explained what directly observed therapy was, 136 patients (68%) found this form of treatment unacceptable.183 patients (91.5%) preferred buying the drugs themselves to visiting a DOTS centre. 90 patients (45%) were not prepared to be observed while swallowing their TB drugs, finding it an intrusion of privacy.
Our study reveals a poor knowledge and awareness of the DOTS programme among the cohort of TB patients that we interviewed. The control of TB in India will undoubtedly benefit from more patients being attracted to and treated by the existing DOTS programmes. However, directly observed treatment, in its present form, is considered too rigid and intrusive and is unlikely to be accepted by a majority of patients seeking private healthcare. Novel strategies and more flexible options will have to be devised to ensure higher cure rates without compromising patient choice.
印度占全球结核病（TB）发病病例的五分之一。该国目前拥有全球最大的直接观察治疗短期疗程（DOTS）项目，该项目取得了令人瞩目的成果，覆盖了超过 10 亿印度人口的近 100%。尽管该项目取得了如此成功，但大多数印度结核病患者还是更喜欢私人医疗保健，尽管对这一领域的多次审计显示其质量较差。我们旨在确定在一家私立三级保健机构就诊的私立结核病患者对 DOTS 项目的认识和了解程度，了解他们选择私立医疗保健的原因，并评估他们对直接观察治疗作为一种治疗选择的接受或拒绝的看法和原因。
在印度孟买的 P.D. Hinduja 医院和医学研究中心，于 2006 年 1 月至 2007 年 11 月期间，对私立结核病患者进行了一项结构化访谈。
只有 200 名患者中的 30 名（15%）了解 DOTS 项目。在解释了什么是直接观察治疗后，有 136 名患者（68%）发现这种治疗形式不可接受。183 名患者（91.5%）更喜欢自己购买药物而不是去 DOTS 中心就诊。90 名患者（45%）不愿意在服用结核病药物时接受观察，认为这侵犯了他们的隐私。
我们的研究表明，我们采访的结核病患者对 DOTS 项目的认识和了解程度较差。印度的结核病控制无疑将受益于更多的患者被吸引并接受现有的 DOTS 项目治疗。然而，直接观察治疗目前的形式被认为过于严格和具有侵犯性，不太可能被寻求私人医疗保健的大多数患者所接受。为了确保在不影响患者选择的情况下提高治愈率，必须制定新的策略和更灵活的选择。
