Thames Valley Heath Protection Unit, Centre for Radiation, Chemical and Environmental Hazards, Health Protection Agency, Chilton, Didcot, UK.
Public Health. 2013 Feb;127(2):171-7. doi: 10.1016/j.puhe.2012.11.010. Epub 2013 Jan 11.
To quantify and determine factors associated with delay in initiation of tuberculosis (TB) treatment in the Thames Valley area, South East England, and the proportion of this delay that could be attributed to patient care-seeking or to delay within the National Health Service (NHS).
Retrospective analysis study reviewing medical notes and enhanced TB surveillance data.
Demographic and clinical information was collected from medical notes and the Enhanced TB Surveillance database for patients who were diagnosed with TB and resident in the Thames Valley. Treatment delay was defined as the period between the onset of symptoms and the start of treatment. Patient delay was defined as the period between the onset of symptoms and the first presentation to the NHS. Health service delay was defined as the period between the first contact with the NHS and the start of treatment. Univariate and multivariate linear regression analyses were used to assess the association between delays and explanatory variables (age, gender, place of birth, ethnicity, disease site, sputum smear, culture, primary care trust of residence).
The study included 273 patients with TB. The median time between symptom onset and initiation of treatment was 73 days [95% confidence interval (CI) 65-89], of which the contributions of health service, patient and referral delays were 39 (95% CI 34-55), 29 (95% CI 22-36) and 16 (95% CI 12-24) days, respectively. On multivariate analysis, extrapulmonary TB (P = 0.010), female (P = 0.003) and UK-born (P = 0.008) patients were associated with longer health service delay. Age (P = 0.001) and extrapulmonary TB (P = 0.010) were associated with longer overall treatment delay.
Treatment delay for TB, especially delay after first presentation to the NHS, remains a public health concern. Differences in health service delay, for example by gender and country of birth, highlight that some of this should be open to health service intervention.
量化并确定导致英国东南部泰晤士河谷地区结核病（TB）治疗延迟的因素，以及该延迟中归因于患者寻求治疗或国家卫生服务（NHS）内部延迟的比例。
回顾性分析研究，审查医疗记录和强化结核病监测数据。
从医疗记录和增强型结核病监测数据库中收集诊断为结核病且居住在泰晤士河谷地区的患者的人口统计学和临床信息。治疗延迟定义为从症状发作到开始治疗的时间间隔。患者延迟定义为从症状发作到首次向 NHS 就诊的时间间隔。卫生服务延迟定义为首次与 NHS 接触到开始治疗的时间间隔。使用单变量和多变量线性回归分析来评估延迟与解释变量（年龄、性别、出生地、族裔、疾病部位、痰涂片、培养、居住地的初级保健信托）之间的关联。
该研究包括 273 例结核病患者。从症状发作到开始治疗的中位时间为 73 天[95%置信区间（CI）65-89]，其中卫生服务、患者和转诊延迟的贡献分别为 39 天（95% CI 34-55）、29 天（95% CI 22-36）和 16 天（95% CI 12-24）。多变量分析显示，肺外结核病（P=0.010）、女性（P=0.003）和英国出生的患者（P=0.008）与更长的卫生服务延迟相关。年龄（P=0.001）和肺外结核病（P=0.010）与整体治疗延迟较长相关。
结核病的治疗延迟，特别是首次向 NHS 就诊后的延迟，仍然是一个公共卫生问题。卫生服务延迟方面的差异，例如按性别和出生地划分，表明其中一些应该可以接受卫生服务干预。
