O'Connell James, Reidy Niamh, McNally Cora, de Barra Eoghan, Stanistreet Debbi, McConkey Samuel
Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
Beaumont Hospital, Dublin, Ireland.
Open Forum Infect Dis. 2022 Apr 2;9(6):ofac164. doi: 10.1093/ofid/ofac164. eCollection 2022 Jun.
Tuberculosis (TB) elimination requires high-quality, timely care. In countries with a low incidence of TB, such as Ireland, delayed diagnosis is common. This evaluation aimed to determine the factors that predict patient-related and health care provider-related delays in TB management and to establish how TB care cost is affected by care delays.
Health care records of patients with signs and symptoms of TB evaluated by a tertiary service in Ireland between July 1, 2018, and December 31, 2019, were reviewed to measure and determine predictors of patient-related delays, health care provider-related delays, and the cost of TB care. Outcomes were compared against benchmarks derived from the literature.
Thirty-seven patients were diagnosed with TB, and 51% (19/37) had pulmonary TB (PTB). The median patient-related delay was 60 days among those with PTB, greater than the benchmark derived from the literature (38 days). The median health care provider-related delay among patients with PTB was 16 days and, although similar to the benchmark (median, 22 days; minimum, 11 days; maximum, 36 days), could be improved. The health care provider-related delay among patients with EPTB was 66 days, greater than the benchmark (42 days). The cost of care was €8298 and, while similar to that reported in the literature (median, €9319; minimum, €6486; maximum, €14 750), could be improved. Patient-related delays among those with PTB predicted care costs.
Patient-related and health care provider-related delays in TB diagnosis in Ireland must be reduced. Initiatives to do so should be resourced.
消除结核病需要高质量、及时的护理。在结核病发病率较低的国家，如爱尔兰，延迟诊断很常见。本评估旨在确定预测结核病管理中患者相关和医疗服务提供者相关延迟的因素，并确定护理延迟如何影响结核病护理成本。
回顾了2018年7月1日至2019年12月31日期间爱尔兰一家三级医疗机构评估的有结核病症状和体征患者的医疗记录，以测量和确定患者相关延迟、医疗服务提供者相关延迟以及结核病护理成本的预测因素。将结果与文献中的基准进行比较。
37例患者被诊断为结核病，51%（19/37）为肺结核（PTB）。PTB患者中患者相关延迟的中位数为60天，高于文献中的基准（38天）。PTB患者中医疗服务提供者相关延迟的中位数为16天，虽然与基准相似（中位数为22天；最小值为11天；最大值为36天），但仍可改善。肺外结核（EPTB）患者中医疗服务提供者相关延迟为66天，高于基准（42天）。护理成本为8298欧元，虽然与文献报道的相似（中位数为9319欧元；最小值为6486欧元；最大值为14750欧元），但仍可改善。PTB患者中与患者相关的延迟可预测护理成本。
必须减少爱尔兰结核病诊断中患者相关和医疗服务提供者相关的延迟。应为此类举措提供资源。
