Mahendradhata Yodi, Lestari Trisasi, Probandari Ari, Indriarini Lucia Evi, Burhan Erlina, Mustikawati Dyah, Utarini Adi
Center for Health Policy and Management, Faculty of Medicine, Gadjah Mada University, Sekip Utara, Yogyakarta, 55281, Indonesia.
Department of Public Health, Faculty of Medicine, Gadjah Mada University, Sekip Utara, Yogyakarta, 55281, Indonesia.
BMC Res Notes. 2015 Oct 14;8:564. doi: 10.1186/s13104-015-1560-7.
Private practitioners (PPs) in high-burden countries often provide substandard tuberculosis (TB) treatment, leading to increased risk of drug resistance and continued transmission. TB case management among PPs in Indonesia has not been investigated in recent years, despite longstanding recognition of inadequate care and substantial investment in several initiatives. This study aimed to assess case management practices of private general practitioners (GPs) in eight major cities across Indonesia.
A cross-sectional survey of private GPs was carried out simultaneously in eight cities by trained researchers between August and December 2011. We aimed for a sample size of 627 in total, and took a simple random sample of GPs from the validated local registers of GPs. Informed consent was obtained from participants prior to interview. Diagnostic and treatment practices were evaluated based on compliance with national guidelines. Descriptive statistics are presented.
Of 608 eligible GPs invited to participate during the study period, 547 (89.9%) consented and completed the interview. A low proportion of GPs (24.6-74.3%) had heard of the International Standards for TB care (ISTC) and only 41.2-68.9% of these GPs had participated in ISTC training. As few as 47.3% (90% CI: 37.6-57.0%) of GPs reported having seen presumptive TB. The median number of cases of presumptive TB seen per month was low (0-5). The proportion of GPs who utilized smear microscopy for diagnosing presumptive adult TB ranged from 62.3 to 84.6%. In all cities, a substantial proportion of GPs (12.0-45.5%) prescribed second-line anti-TB drugs for treating new adult TB cases. In nearly all cities, less than half of GPs appointed a treatment observer (13.8-52.0%).
The pattern of TB case management practices among private GPs in Indonesia is still not in line with the guidelines, despite longstanding awareness of the issue and considerable trialing of various interventions.
高负担国家的私人执业医生（PPs）常常提供不合格的结核病（TB）治疗，导致耐药风险增加及疾病持续传播。尽管长期以来人们认识到印度尼西亚私人执业医生的结核病病例管理存在不足，且在多项举措上投入巨大，但近年来该国私人执业医生的结核病病例管理情况尚未得到调查。本研究旨在评估印度尼西亚八个主要城市的私人全科医生（GPs）的病例管理实践。
2011年8月至12月期间，经过培训的研究人员在八个城市同时对私人全科医生开展了一项横断面调查。我们的目标样本总量为627人，从经过验证的当地全科医生登记册中简单随机抽取全科医生。在访谈前获得了参与者的知情同意。根据对国家指南的遵守情况评估诊断和治疗实践。给出描述性统计结果。
在研究期间邀请参与的608名符合条件的全科医生中，547名（89.9%）同意并完成了访谈。听说过《国际结核病防治标准》（ISTC）的全科医生比例较低（24.6 - 74.3%），且这些全科医生中只有41.2 - 68.9%参加过ISTC培训。报告见过疑似结核病患者的全科医生少至47.3%（90%置信区间：37.6 - 57.0%）。每月见过的疑似结核病病例中位数较低（0 - 5例）。利用涂片显微镜检查诊断疑似成人结核病的全科医生比例在62.3%至84.6%之间。在所有城市，相当比例的全科医生（12.0 - 45.5%）为治疗新的成人结核病病例开具二线抗结核药物。在几乎所有城市，不到一半的全科医生指定了治疗观察员（13.8 - 52.0%）。
尽管长期以来人们已认识到该问题，并对各种干预措施进行了大量试验，但印度尼西亚私人全科医生的结核病病例管理模式仍不符合指南要求。
