Department for Tuberculosis, Hospital for Lung Disease and Tuberculosis Brezovik, Niksic, Montenegro.
Faculty of Medicine at the University of Montenegro, Podgorica, Montenegro.
PLoS One. 2018 Mar 9;13(3):e0193997. doi: 10.1371/journal.pone.0193997. eCollection 2018.
Fundamental measures of control of tuberculosis are early detection and timely treatment of the affected. The aim of this study was to identify factors associated with patient-related and health system-related delays among patients with tuberculosis in the Republic of Montenegro.
A cross-sectional study included 130 tuberculosis patients older than 15 years of age. The inclusion criteria were diagnosis of tuberculosis based on clinical, pathohistological and microbiological findings. Patient delay referred to the number of days between the onset of symptoms and the first consultation with general practitioner (GP). Health system delay represented the number of days between the first consultation with GP and the initiation of tuberculosis treatment.We classified delays longer than median delay length as 'prolonged delays'. Delays greater than 75th percentile of the maximum length of delay were classified as 'extreme delays'.
Distribution of patient and health system delay in the overall delay was apprioximately equal (49% vs. 51%). Being married (OR = 2.54, p = 0.026) and having more negative attitudes towards tuberculosis (OR = 4.00, p = 0.045) were associated with extreme patient delay. Greater knowledge on tuberculosis was associated with lower likelihood of prolonged (OR = 0.24, p = 0.031) and extreme (OR = 0.30, p = 0.012) patient delay. Persons with negative sputum smear were more likely to experience prolonged (OR = 7.01, p<0.001) and extreme (OR = 4.40, p = 0.032) health system delay. Persons older than 47 years of age were more likely to experience prolonged health system delay (OR = 2.61, p = 0.042). Specialist consultation delay was associated with prolonged (OR = 1.08, p = 0.001) and extreme (OR = 1.05, p<0.001) health system delay.
Contribution to overall delay is equally distributed between the patients and the health care system. Improvement of knowledge in the general population and continuing medical education of the health care workers on tuberculosis could lead to reduction in patient and health system delays in treatment of tuberculosis.
结核病控制的基本措施是早期发现和及时治疗受影响者。本研究的目的是确定与黑山共和国结核病患者相关的患者相关和卫生系统相关延迟的因素。
这项横断面研究包括 130 名年龄在 15 岁以上的结核病患者。纳入标准为基于临床、病理和微生物学发现诊断为结核病。患者延迟是指从症状出现到首次咨询全科医生（GP）之间的天数。卫生系统延迟表示从首次咨询 GP 到开始结核病治疗之间的天数。我们将长于中位数延迟长度的延迟分类为“延长的延迟”。将大于最大延迟长度的 75 百分位数的延迟分类为“极端延迟”。
总体延迟中患者和卫生系统延迟的分布大致相等（49%比 51%）。已婚（OR=2.54，p=0.026）和对结核病的态度更消极（OR=4.00，p=0.045）与极端患者延迟有关。对结核病有更多的了解与延长（OR=0.24，p=0.031）和极端（OR=0.30，p=0.012）患者延迟的可能性较低相关。痰涂片阴性的人更有可能经历延长（OR=7.01，p<0.001）和极端（OR=4.40，p=0.032）的卫生系统延迟。年龄大于 47 岁的人更有可能经历延长的卫生系统延迟（OR=2.61，p=0.042）。专科医生咨询延迟与延长（OR=1.08，p=0.001）和极端（OR=1.05，p<0.001）的卫生系统延迟有关。
在总体延迟中，患者和医疗保健系统的贡献相等。提高普通人群的知识水平，并对医疗保健工作者进行结核病继续教育，可以减少结核病治疗中的患者和卫生系统延迟。
