Patient's site of first access to health system influences length of delay for tuberculosis treatment in Tajikistan

Ayé, Raffael; Wyss, Kaspar; Abdualimova, Hanifa; Saidaliev, Sadullo

doi:10.1186/1472-6963-10-10

Cited by 26 publications

(28 citation statements)

References 17 publications

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“…The average number of visits made before commencing treatment after an initial visit to a non-NTP provider was higher because TB might not have been considered during the first visit to the informal providers, as a result; the patients might have been given inappropriate care which led to several other visits before reaching the appropriate health facility for TB care. However, median number of visits made irrespective of the source of care in this study were similar to what was found in South Africa [26], but less than what was found in Tajikistan and urban Zambia, where TB patients made on the average 4.8 and 6.7 visits respectively [27,28]. Additional strategies to shorten the interval between HCP visits in the diagnostic pathway may further reduce health system delay in our setting and improve TB control.…”

Section: Discussionsupporting

confidence: 80%

Healthcare-seeking behavior, treatment delays and its determinants among pulmonary tuberculosis patients in rural Nigeria: a cross-sectional study

Ukwaja

Alobu

Nweke

et al. 2013

BMC Health Serv Res

136

101

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BackgroundNigeria ranks fourth among 22 high tuberculosis (TB) burden countries. Although it reached 99% DOTS coverage in 2008, current case detection rate is 40%. Little is known about delays before the start of TB therapy and health-seeking behaviour of TB patients in rural resource-limited settings. We aimed to: 1) assess healthcare-seeking behaviour and delay in treatment of pulmonary TB patients, 2) identify the determinants of the delay in treatment of pulmonary TB.MethodsWe conducted a cross-sectional study of adult new pulmonary TB patients notified to the National Tuberculosis Control Programme (NTP) by three rural (two mission/one public) hospitals. Data on health-seeking and delays were collected using a standardised questionnaire. We defined patient delay as the interval (weeks) between the onset of cough and the first visit to any health provider, and health system delay as the time interval (weeks) between patient's first attendance to any health provider, and the onset of treatment. Total delay is the sum of both delays. Multiple linear regression models using nine exposure variables were built to identify determinants of delays.ResultsOf 450 patients (median age 30 years) enrolled, most were males (55%), subsistent farmers (49%), rural residents (78%); and 39% had no formal education. About 84% of patients reported first consulting a non-NTP provider. For such patients, the first facilities visited after onset of symptoms were drug shops (79%), traditional healers (10%), and private hospitals (10%). The median total delay was 11 (IQR 9–16) weeks, patient delay 8 (IQR 8–12) and health system (HS) delay 3 (IQR 1–4) weeks. Factors associated with increased patient delay were older age (P <0.001) longer walking distance to a public facility (<0.001), and urban residence (P <0.001). Male gender (P = 0.001) and an initial visit to a non-NTP provider (P = 0.025) were independent determinants of prolonged HS delay. Those associated with longer total delay were older age (P <0.001), male gender (P = 0.045), and urban residence (P<0.001).ConclusionOverall, TB treatment delays were high; and needs to be reduced in Nigeria. This may be achieved through improved access to care, further education of patients, engagement of informal care providers, and strengthening of existing public-private partnerships in TB control.

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Section: Discussionsupporting

confidence: 80%

Healthcare-seeking behavior, treatment delays and its determinants among pulmonary tuberculosis patients in rural Nigeria: a cross-sectional study

Ukwaja

Alobu

Nweke

et al. 2013

BMC Health Serv Res

136

101

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“…However, the data showed a tendency only and should be interpreted with care. The long treatment delays experienced by migrants developing TB in Russia could have contributed to higher costs (Ayé et al. 2010b).…”

Section: Discussionmentioning

confidence: 99%

Factors determining household expenditure for tuberculosis and coping strategies in Tajikistan

Ayé¹,

Wyss²,

Abdualimova³

et al. 2011

Tropical Med Int Health

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Summaryobjective To investigate factors influencing expenditure levels and the use of potentially detrimental coping strategies among tuberculosis (TB) patients. For the purpose of the present study, potentially detrimental coping strategies included borrowing money and selling assets.method Questionnaire survey with an initial and a follow-up interview of each adult new pulmonary TB case registered over a period of 4 months, conducted in 12 districts with DOTS in Tajikistan, one of the poorest countries in the world.results Patients and their households faced mean expenditures of US$ 396 related to a TB episode. In multivariate mixed-effect regression models, the main determinants of out-of-pocket payments-either over the whole course of the disease or after enrolment in DOTS treatment-were 'complimentary treatment' besides the anti-TB drugs, duration of hospitalization and treatment delay. Complimentary treatment mainly consisted of vitamins and rehydrating infusions. Sex showed no association with expenditure.

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“…Healthcare access consisted of six domains: ‘primary care access’, 6–9, 15,20,27–31 ‘specialty care access’, 8,30 ‘urgent care access’, 9,20 ‘spatial access’ (including geographic and transportation barriers), 8,11,14,15,27,29,31,32–37 ‘communication access between visits’, 9,21,22,27 and ‘cultural access’ (including familiarity with patient’s culture and language barriers). 27, 29 The five domains related to care coordination included: ‘longitudinal continuity’, 5,8,9,11,25,31,36,38–42 ‘relational continuity’ (defined as patient developing trust and respect for provider over time), 10,11,23,25,29,36,39–46 ‘informational continuity’ (all providers have access to comprehensive patient information), 5,10–12,14,21–23,25,36,38–46 ‘cross-boundary coordination’ (coordination across different health care settings or systems), 11,21,25,39,41,45 and ‘follow up coordination’ (coordination related to appointments, medications, testing, or procedures recommended by initial visit). 9,21,22 …”

Section: Resultsmentioning

confidence: 99%

Survey Instruments to Assess Patient Experiences With Access and Coordination Across Health Care Settings

et al. 2017

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Background Improving access can increase the providers a patient sees, and cause coordination challenges. For initiatives that increase care across healthcare settings, measuring patient experiences with access and care coordination will be crucial. Objectives Map existing survey measures of patient experiences with access and care coordination expected to be relevant to patients accessing care across settings. Preliminarily examine whether aspects of access and care coordination important to patients are represented by existing measures. Research Design Structured literature review of domains and existing survey measures related to access and care coordination across settings. Survey measures, and preliminary themes from semi-structured interviews of 10 patients offered VA-purchased Community Care, were mapped to identified domains. Results We identified 31 existing survey instruments with 279 items representing 6 access and 5 care coordination domains relevant to cross-system care. Domains frequently assessed by existing measures included follow up coordination, primary care access, cross-setting coordination, and continuity. Preliminary issues identified in interviews, but not commonly assessed by existing measures included: 1) acceptability of distance to care site given patient’s clinical situation, 2) burden on patients to access and coordinate care and billing, 3) provider familiarity with Veteran culture and VA processes. Conclusions Existing survey instruments assess many aspects of patient experiences with access and care coordination in cross-system care. Systems assessing cross-system care should consider whether patient surveys accurately reflect the level of patients’ concerns with burden to access and coordinate care, and adequately reflect the impact of clinical severity and cultural familiarity on patient preferences.

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Patient's site of first access to health system influences length of delay for tuberculosis treatment in Tajikistan

Cited by 26 publications

References 17 publications

Healthcare-seeking behavior, treatment delays and its determinants among pulmonary tuberculosis patients in rural Nigeria: a cross-sectional study

Healthcare-seeking behavior, treatment delays and its determinants among pulmonary tuberculosis patients in rural Nigeria: a cross-sectional study

Factors determining household expenditure for tuberculosis and coping strategies in Tajikistan

Survey Instruments to Assess Patient Experiences With Access and Coordination Across Health Care Settings

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