How do private general practitioners manage tuberculosis cases? A survey in eight cities in Indonesia

Abstract

BackgroundPrivate 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.MethodsA 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.ResultsOf 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 %).ConclusionsThe 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.

District‐level impacts of health system decentralization in Indonesia: A systematic review

“…District‐level disease reporting has not yet been implemented according to the strategy even for priority diseases such as tuberculosis . Although possessing sufficient work experience, the vast majority of GPs in Indonesia's major cities were not aware of the International Standards for Tuberculosis Care (ISTC), resulting in low implementation of the ISTC strategy.…”

“…The highest tuberculosis reporting rate was found in Semarang and it was only 17% of the total cases. The lowest reporting rate was detected in Jayapura (3%), Papua province …”

“…51 District-level disease reporting has not yet been implemented according to the strategy even for priority diseases such as tuberculosis. 47 Although possessing sufficient work experience, the vast majority of GPs in Indonesia's major cities were not aware of the International Standards for Tuberculosis Care (ISTC), resulting in low implementation of the ISTC strategy. In turn, that has led to low utilization of tuberculosis diagnostic tests, improper prescribed medication, and a high rate of unreported tuberculosis cases particularly at district level.…”

“…In turn, that has led to low utilization of tuberculosis diagnostic tests, improper prescribed medication, and a high rate of unreported tuberculosis cases particularly at district level. 47 The implemented strategies for malaria surveillance in Purworejo have led to a high level of unreported malaria incidence, increase barriers to diagnosis validation, and antimalarial drugs shortages. Between 2007 and 2011, only 26% of the total cases were reported.…”

Knowledge and Attitude about Multidrug-Resistant Tuberculosis among Healthcare Workers in Public Health Centres

“…These gaps were similar with other findings from other investigators. [10][11][12][13] Based on personal characteristics of study participants such as age, gender, professional category, number of years of working experience, and history of TB training, there was no evidence from this study demonstrating that there was any significant difference among study participants with regard to their knowledge and attitude about MDR-TB.…”