Patient and Doctor Delays in Smear-Negative and Smear-Positive Pulmonary Tuberculosis Patients Attending a Referral Hospital in Istanbul, Turkey

Abstract

Objectives. To measure delays from onset of symptoms to initiation of treatment in patients with smear-negative and smear-positive pulmonary tuberculosis and to identify reasons for these delays. Methods. A total of 136 newly diagnosed pulmonary tuberculosis patients were interviewed using a structured questionnaire. Results. The patients were divided into two groups. Group 1 included 65 smear-negative patients. There were 71 smear-positive patients in group 2. The median application interval was 10 days in group 1 and 14 days in group 2. While 24.6% of the patients had patient delay in group 1, patient delay was present in 33.8% of the patients in group 2 (P > 0.05). The median health care system interval was 41 days in group 1 and 16 days in group 2 (P < 0.0001). The most common reason for patient delay was neglect of symptoms by patient in both groups. A low index of suspicion for tuberculosis by physicians was the most common reason for doctor delays. Conclusions. Delays are common problem in smear-negative and smear-positive pulmonary tuberculosis patients. Delays should be reduced to reach an effective tuberculosis control. Education of public and physicians about tuberculosis is the most important effort to reduce delays.

Delays in the Diagnosis and Treatment of Pulmonary Tuberculosis

“…Although the authors have described different duration intervals for the criteria of delays, the following operational criteria for delays have been usually used in most studies. Patient delay: The patient's application intervals that exceeded 30 days were considered indicative of a patient delay in smear-negative and smear-positive patients (10,12,(20)(21)(22). Health care system delay or doctor delay: While health care system intervals that exceeded four days were considered indicative of a doctor delay in smear-positive patients (10,20,22), a period of more than 15 days was indicative of a doctor delay in smear-negative patients (12,22).…”

“…Patient delay: The patient's application intervals that exceeded 30 days were considered indicative of a patient delay in smear-negative and smear-positive patients (10,12,(20)(21)(22). Health care system delay or doctor delay: While health care system intervals that exceeded four days were considered indicative of a doctor delay in smear-positive patients (10,20,22), a period of more than 15 days was indicative of a doctor delay in smear-negative patients (12,22). Referral delay: The referral intervals that exceeded two days were considered indicative of a referral delay in smear-negative and smear-positive patients (10,(20)(21)(22).…”

“…Health care system delay or doctor delay: While health care system intervals that exceeded four days were considered indicative of a doctor delay in smear-positive patients (10,20,22), a period of more than 15 days was indicative of a doctor delay in smear-negative patients (12,22). Referral delay: The referral intervals that exceeded two days were considered indicative of a referral delay in smear-negative and smear-positive patients (10,(20)(21)(22). Diagnosis delay: The diagnosis interval that exceed one day was considered indicative of a delayed diagnosis in smear-positive patients (10,20).…”

“…Treatment delay: The treatment interval that exceed one day was defined as a delayed treatment (10,20,21). Clinical delay: While clinical intervals that exceeded two days were considered indicative of a clinic delay in smear-positive patients, a period of more than 13 days was indicative of a clinical delay in smear-negative patients (10,12,20,22). Total delay: While total intervals that exceeded 34 days were considered indicative of a total delay in smearpositive patients, a period of more than 45 days was indicative of a total delay in smear-negative patients (10,12,20,22).…”

“…While most studies include smearpositive pulmonary tuberculosis patients, the number of studies evaluating delays in smear-negative and extrapulmonary tuberculosis patients is limited. Table 1 shows the results of several studies (5,11,17,(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). Sub-categories of doctor delay were evaluated in some studies.…”