Dataset Information

Patient and health system delays before registration among migrant patients with tuberculosis who were transferred out in China.

ABSTRACT:

Background

Early diagnosis and treatment is vital for effective tuberculosis (TB) management especially among migrant populations who are a vulnerable group. We aimed to study factors associated with delay before registration at country level among registered migrant TB patients in China (2014-15) who were transferred out (during treatment) through web-based TB information management system (TBIMS).

Methods

This was a cross sectional study involving review of TBIMS data. Delays (in days) were classified as follows: patient delay (from symptom onset to first doctor visit), health system delay (from first doctor visit to treatment initiation, divided into health system diagnosis and treatment delay before and after date of diagnosis respectively), diagnosis delay (from symptom onset to diagnosis) and total delay (from symptom onset to treatment initiation). Linear regression was used to build a predictive model (forward stepwise) for the socio-demographic, clinical and health system related factors associated with delay: one model for each type of delay. Delays were log transformed and included in the model.

Results

The median (IQR) patient delay, health system delay and total delay was 16 (6, 34), two (0, 6) and 22 (11, 41) days respectively. Factors associated with long patient, diagnosis and total delay were: female gender, age???65 years, sputum smear positive pulmonary TB and registration at referral hospital. Treatment initiation delay was significantly higher among those registered in referral hospitals, unemployed and previously treated. Among migrant patients having permanent residence out of province, health system diagnosis delay was significantly higher while treatment initiation delay after diagnosis was significantly lower when compared to patients having permanent residence within the prefecture.

Conclusion

Among migrant population with TB, patient delay contributed to the total delay. The factors identified including the need for improved coordination between referral hospitals and national programme have to be addressed if China has to end TB.

SUBMITTER: Li T

PROVIDER: S-EPMC6194607 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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Publications

Patient and health system delays before registration among migrant patients with tuberculosis who were transferred out in China.

Li Tao T Zhang Hui H Shewade Hemant Deepak HD Soe Kyaw Thu KT Wang Lixia L Du Xin X

BMC health services research 20181019 1

<h4>Background</h4>Early diagnosis and treatment is vital for effective tuberculosis (TB) management especially among migrant populations who are a vulnerable group. We aimed to study factors associated with delay before registration at country level among registered migrant TB patients in China (2014-15) who were transferred out (during treatment) through web-based TB information management system (TBIMS).<h4>Methods</h4>This was a cross sectional study involving review of TBIMS data. Delays (i ...[more]

PMID: 30340489

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Project description:BackgroundIn China, internal migrants constitute one-fifth of tuberculosis (TB) patients registered for treatment in web-based TB information management system (TBIMS). Though China added a specific module in the web-based TBIMS in 2009, web-based transfer-out is not specifically recommended in the national guidelines.ObjectiveIn this country wide study among all registered migrant TB patients (2014-2015) that were transferred out using web-based TBIMS in China, to determine the i) timing of transfer-out in relation to period of treatment; ii) delay and attrition during transfer interval (between transfer-out and transfer-in); and iii) extent and risk factors for 'not evaluated' as the treatment outcome.MethodsThis was a cohort study involving review of web-based TBIMS data. Modified Poisson regression was used to build a predictive model for risk factors of 'not evaluated' as the treatment outcome.ResultsAmong 7 284 patients, 5 900 (81.0%) were transferred out during the first two months after initiation of treatment or before treatment initiation and 7 088 (97.3%) patients had arrived at transfer-in unit. The median transfer interval was three (interquartile range: 0-14) days. Sixteen percent (1 176/7 284) patients had 'not evaluated' as their treatment outcome. 'Not evaluated' contributed to 66% of the unfavourable outcomes. Patients transferred from referral hospitals, migrated from out of prefecture, transferred out of prefecture, with sputum smear negative pulmonary TB, with TB pleurisy and with long delay between symptom onset and treatment initiation had significantly higher risk of 'not evaluated' as the outcome.ConclusionWeb-based transfer helped as the delay and attrition during the transfer interval was quite short and treatment outcomes of more than four-fifths of transferred out migrant TB patients were available with transfer-out BMU. Once strategies to address the independent predictors of 'not evaluated' treatment outcome are devised, China may consider mandatory use of web-based TBIMS for transferring out migrant TB patients.

Project description:BackgroundFundamental 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.MethodsA 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'.ResultsDistribution 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.ConclusionContribution 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.

Project description:BackgroundIn China, a long waiting time for registration is a common occurrence in many tertiary hospitals. This study aimed to analyze the effects of a comprehensive reservation service for non-emergency registration on appointment registration rate, patient waiting time, patient satisfaction and outpatient volume at the Guangzhou Women and Children's Medical Center.MethodsThis was a cross-sectional study. This study investigated the effects of a comprehensive reservation service for non-emergency registration in Guangzhou Women and Children's Medical Center in China starting in October 2015. In total, 2194 patients completed a satisfaction survey administered by the Guangdong Situation Research Center. The content of the questionnaire consisted of six aspects: general impression, service attitude, service quality, hospital environment, price perception and medical ethics. A Likert 5-point rating scale was used in the questionnaire; answers were classified as "very satisfied", "relatively satisfied", "neutral", "unsatisfied" and "very unsatisfied". The method of application was paper-based. T-tests were used to compare the sample means, and chi-square tests were used to compare the rates. A multiple-test procedure was performed to evaluate the differences in the reservation rates during a 12-month period.ResultsAfter the implementation of the comprehensive reservation service for non-emergency registration in our hospital, which has an annual outpatient volume of approximately 4 million, the monthly appointment registration rate increased from (34.95 ± 2.91)% to(89.13 ± 3.12)%,P < 0.01. The patient waiting time was significantly reduced (P < 0.01), and the proportion of patients who believed that the waiting time required improvement was decreased significantly (P < 0.01). Moreover, the third-party evaluation result of outpatient satisfaction significantly improved (P < 0.01). The total hospital outpatient volume decreased(P < 0.01). The outpatient volume of the Department of General Pediatrics decreased.ConclusionThe implementation of the comprehensive reservation service for non-emergency registration in the hospital shortened patient waiting time and improved patient satisfaction, and the outpatient volume was effectively controlled. These results indicated that this program obtained the desired results in a Grade 3A hospital in China.

Project description:BackgroundTuberculosis (TB) continues to be a major public health challenge in China. Understanding TB management delays within the context of China's unique ethnic diversity may be of value in tackling the disease. This study sought to evaluate the impact of ethnic minority status on TB diagnosis and treatment delays.MethodsThis retrospective cohort study was conducted on patients diagnosed with TB in Hunan Province, China between 2013 and 2018. Diagnosis delay was defined as the time interval between the onset of symptoms and the date of diagnosis. Treatment delay was defined as the time interval between diagnosis and treatment commencement. Univariable and multivariable logistic regression models were used to identify factors associated with TB diagnosis and treatment delay, including ethnic minority status. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were calculated to assess the strength of association between the dependant and independent variables.ResultsA total of 318,792 TB patients were included in the study with a mean age of 51.7 years (SD 17.7). The majority of patients were male (72.6%) and Han ethnicity (90.6%). The odds of experiencing diagnosis delay (> 21 days) were significantly higher for Tujia (AOR: 1.46, 95% CI: 1.41, 1.51), Miao (AOR: 1.31, 95% CI: 1.26, 1.37), Dong (AOR: 1.97, 95% CI: 1.85, 2.11), Yao (AOR: 1.27, 95% CI: 1.17, 1.37), and Bai (AOR: 1.45, 95% CI: 1.22, 1.74) ethnic minorities compared to the Han majority. The odds of experiencing treatment delay (> 15 days) were significantly lower for five of the seven ethnic minority groups relative to the Han majority: Tujia (AOR 0.92, 95% CI 0.88, 0.96), Miao (AOR 0.74, 95% CI 0.70, 0.79), Dong (AOR 0.87, 95% CI 0.81, 0.95), Yao (AOR 0.20, 95% CI 0.17, 0.24) and 'other' (ethnic minorities that individually represented < 0.1% of the patient population) (AOR 0.70, 955 CI 0.51, 0.97).ConclusionsThis study shows ethnic minority status to be a significant risk factor in diagnosis delay, but for it to reduce the odds of treatment delay. Further research is required to determine the underlying causes of diagnosis delay within ethnic minority populations.

Project description:BackgroundEarly diagnosis and treatment of pulmonary tuberculosis (PTB) is essential for an effective control of the tuberculosis (TB) epidemic. Delayed diagnosis and treatment of TB increases the chance of complications and mortality for the patients, and enhances TB transmission in the population. Therefore, the aim of this study was to characterize patient, healthcare and total delay in diagnosing PTB and assess the effect of clinical and sociodemographic factors on the time until first contact with healthcare or reaching a PTB diagnosis.MethodsRetrospective cohort study that included active PTB patients notified in the National Tuberculosis Surveillance System (SVIG-TB), between 2008 and 2017. Descriptive statistics, Kaplan-Meier estimates, logrank test and Cox proportional hazards model were used to characterize patient, healthcare and total delay and estimate the effect of clinical and sociodemographic variables on these delays. Significance level was set at 0.05.ResultsMedian patient, healthcare and total delays was 37 days (Interquartile range (IQR): 19-71), 8 days (IQR: 1-32) and 62 days (IQR: 38-102), respectively. The median patient delay showed a constant increase, from 33 days in 2008 to 44 days in 2017. The median total delay presented a similar trend, increasing from 59 days in 2008 to 70 days in 2017. Healthcare delay remained constant during the study period. More than half of the PTB cases (82.9%) had a delay > 1 month between symptom onset and diagnosis. In the final Cox model, alcohol abuse, unemployment and being from a high TB incidence country were factors significantly associated with longer patient delay, while being female, having more than 45 years, oncologic and respiratory diseases were associated with longer healthcare delay. Being female, having more than 45 years and being from a high TB incidence country were associated with longer total delay.ConclusionsPatient delay and total delay have increased in recent years. Older patients, patients with alcohol problems, other comorbidities, unemployed or from countries with high TB incidence would benefit from the development of specific public health strategies that could help reduce the delay in TB diagnosis observed in our study. This study emphasizes the need to promote awareness of TB in the general population and among the healthcare community, especially at ambulatory care level, in order to reduce the gap between beginning of symptoms and TB diagnosis.

Project description:BackgroundUnderstanding patient pathways can help align patient preferences and tuberculosis (TB) related services. We investigated patient pathways, and diagnostic and treatment delays among TB patients in Indonesia, which has one of the highest proportions of non-notified TB cases globally.MethodsWe conducted a study of TB patients recruited from Community Health Centers (CHCs), public and private hospitals, and private practitioners from 2017 to 2019 in Bandung City, regarding general characteristics and symptoms, and health-seeking, diagnostic and treatment pathways.FindingsWe recruited 414 TB patients: 138 (33%) in CHCs, 210 (51%) in hospitals, 66 (20%) in private practitioners. Most patients (74·6%) first sought care at an informal or private provider and experienced a complex pathway visiting both public and private providers to obtain a diagnosis. The median number of health provider visits pre-diagnosis was 6 (IQR 4-8). From start of symptoms, it took a median 30 days (IQR 14-61) to present to a health provider, 62 days (IQR 35-113) to reach a TB diagnosis, and 65 days (IQR 37-119) to start treatment. Patient delay was longer among male, lowly-educated and uninsured individuals. There were longer diagnostic delays among uninsured individuals, those who initially visited private providers, and those with multiple visits prior to diagnosis. Longer treatment delays were found in those with multiple pre-diagnosis visits or diagnosed by private practitioners.InterpretationPatient pathways in Indonesia are complex, involving the public and private sector, with multiple visits and long delays, especially to diagnosis. A widely available accurate diagnostic test for TB could have a dramatic effect on reducing delays, onward transmission and mortality.FundingThis project was funded by the Partnership for Enhanced Engagement in Research (PEER) grant under Prime Agreement Number AID-OAA-A-11-00,012 by National Academy of Sciences (NAS); the United States Agency for International Development (USAID); University of Otago, New Zealand, and the Indonesian Endowment Fund for Education (LPDP).

Dataset Information

Patient and health system delays before registration among migrant patients with tuberculosis who were transferred out in China.

Background

Methods

Results

Conclusion

Publications

Patient and health system delays before registration among migrant patients with tuberculosis who were transferred out in China.

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