McDowell A, Pai M
McGill International TB Centre & Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
Int J Tuberc Lung Dis. 2016 Apr;20(4):536-43. doi: 10.5588/ijtld.15.0562.
Mismanagement of TB is a concern in the Indian private sector, and empirical management might be a key contributor.
To understand factors associated with empirical diagnosis and treatment of presumed TB in India's private sector and examine their effects on TB care.
In this ethnographic study, 110 private practitioners of varying qualification who interacted with TB patients (90 in Mumbai and 20 in Patna) were interviewed, and a subset was observed while providing clinical care. Interviews and observations were analysed for indicators of empirical diagnosis and treatment.
All non-specialist practitioners began antibiotic treatment, especially quinolones, for persistent cough before prescribing a test. Several factors contribute to empirical management. These include a common practice use of medications as diagnostic tools, a desire to provide rapid symptom relief to patients, a desire to manage illness costs effectively, uncertainty about the presentation of TB, the effects of broad spectrum antibiotics on TB symptomology, and uncertainty about the accuracy of available TB tests.
Empiricism in general and in TB care is widespread in the urban private sector in India. Ethnography might offer useful insights for addressing this in public-private mix models.
结核病管理不善是印度私营部门关注的问题，经验性治疗可能是一个关键因素。
了解印度私营部门假定结核病经验性诊断和治疗的相关因素，并研究其对结核病护理的影响。
在这项人种学研究中，对110名与结核病患者有接触的不同资质的私人执业医生（孟买90名，巴特那20名）进行了访谈，并在其提供临床护理时对其中一部分进行了观察。对访谈和观察结果进行分析，以找出经验性诊断和治疗的指标。
所有非专科医生在开检查单之前，都会对持续性咳嗽患者开始使用抗生素治疗，尤其是喹诺酮类药物。有几个因素导致了经验性治疗。这些因素包括普遍将药物用作诊断工具、希望迅速缓解患者症状、希望有效控制疾病成本、对结核病表现的不确定性、广谱抗生素对结核病症状的影响以及对现有结核病检测准确性的不确定性。
经验性治疗在印度城市私营部门普遍存在，在结核病护理中也是如此。人种学可能为公私混合模式中解决这一问题提供有用的见解。
