Determinants of patient and health-care system delay in the diagnosis of tuberculosis in Sicily

Background: Knowing delays in treatment seeking and subsequent treatment initiation among the TB patients is important and its detailed understanding is crucial in modifying the treatment seeking behaviour which can help in reducing the TB burden and the transmission in the community. Aim & Objective: To study the treatment seeking behaviour including the delays in initiation of treatment along with its determinants; among tuberculosis patients aged > 15 years in Mehrauli area of Delhi. Settings and Design: A longitudinal follow up study conducted in two randomly selected DMC cum DOTS centres in Mehrauli area of Delhi from January 2018 to April 2018. Methods and Material: Patients of both sexes of age > 15 years, registered under RNTCP from January to April 2018 in the randomly selected DOTS centres i.e. Mehrauli DMC cum DOTS and Chattarpur DMC cum DOTS centre were included in the study. Self-designed, pretested interview schedule and records of DMC were used to collect the relevant information. Statistical analysis used: Information collected in the Performa was coded and entered in Statistical Package for Social Sciences (SPSS) version 12. Results: The mean patients delay, diagnostic delay, treatment delay, health care system delay and total delay was 48.91 ± 130.38 days, 91.09 ± 155.97 days, 6.25 ± 6.29 days, 62.72 ± 119.48 days and 97.33 ± 155.06 days respectively. The median patients delay, diagnostic delay, treatment delay, health care system delay and total delay was 15 days, 45 days, 5 days, 35 days and 54 days respectively. Conclusions: The major reasons for patient’s delay were lack of awareness regarding the symptoms of TB and self-medication and for health care system delay it was treatment from private health care providers.

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Factors Associated with Treatment Delay among Pulmonary Tuberculosis Patients in Public and Private Health Facilities in Addis Ababa, Ethiopia

Tuberculosis Research and Treatment ◽

10.1155/2017/5120841 ◽

2017 ◽

Vol 2017 ◽

pp. 1-9 ◽

Cited By ~ 10

Author(s):

Getinet Shewaseged Adenager ◽

Fessahaye Alemseged ◽

Henok Asefa ◽

Amanuel Tesfay Gebremedhin

Keyword(s):

Health Care ◽

Health Care System ◽

Addis Ababa ◽

Treatment Delay ◽

System Delay ◽

Pulmonary Tb ◽

Experienced Patient ◽

Tb Treatment ◽

Total Treatment ◽

Care System

Background. Early detection and diagnosis of tuberculosis (TB) and the timely commencement of antituberculosis (anti-TB) treatment are the parts of efficient tuberculosis prevention and control program. Delay in the commencement of anti-TB treatment worsens the prognosis and increases the risk of death and the chance of transmission in the community and among health care workers. Objective. To assess tuberculosis treatment delay and associated factors among pulmonary TB patients in Addis Ababa, Ethiopia. Methods. A cross-sectional study was conducted in 10 public and 10 private health facilities that provide TB treatment. The data were collected from 425 newly registered pulmonary TB patients using pretested structured questionnaire from April to June 2012. Data were entered in EPI info version 3.5.1 and analyzed using SPSS version 16.0. Findings. The median durations of a patient, health care system, and total treatment delays were 17, 9, and 35 days, respectively. Overall 179 (42.1%), 233 (54.8%), and 262 (61.6%) of patients experienced patient delay, health care system delay, and total treatment delay, respectively. Distance more than 2.5 km from TB treatment health facility [AOR = 1.6, 95% CI (1.1–2.5)] and the presence of TB-associated stigma [AOR = 2.1, 95% CI (1.3, 3.4)] indicate higher odds of patient delay, whereas, being unemployed, patients with the hemoptysis symptom complain indicated lower odds of health care system delay [AOR = 0.41, 95% CI (0.24, 0.70)] and [AOR = 0.61 (0.39, 0.94)], respectively. Conclusions. A significant proportion of clients experienced patient and health care system delay. Thus, there is a need for designing and implementing appropriate strategies to decrease the delays. Efforts to reduce delays should give focus on integrating prevention programs such as active case detection and expanding access to TB care.

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Factors associated with patient and health care system delay in the diagnosis of tuberculosis in France

The International Journal of Tuberculosis and Lung Disease ◽

10.5588/ijtld.11.0420 ◽

2012 ◽

Vol 16 (4) ◽

pp. 510-515 ◽

Cited By ~ 27

Author(s):

P. Tattevin ◽

D. Che ◽

P. Fraisse ◽

C. Gatey ◽

C. Guichard ◽

...

Keyword(s):

Health Care ◽

Health Care System ◽

System Delay ◽

Factors Associated ◽

Care System

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Patient and health care system characteristics are associated with delayed treatment of tuberculosis cases in Taiwan

BMC Health Services Research ◽

10.1186/s12913-019-4702-0 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Chien-Chou Chen ◽

Po-Huang Chiang ◽

Yen-Hsu Chen ◽

I-Chun Fan ◽

Ta-Chien Chan

Keyword(s):

Risk Factors ◽

Health Care ◽

Health System ◽

Health Care System ◽

Initial Visit ◽

System Delay ◽

Tuberculosis Patients ◽

Health System Delay ◽

Treatment Services ◽

Care System

Abstract Background The decline of the incidence rate of tuberculosis in Taiwan has been partly attributed to the launch of the directly observed therapy short course (DOTS) program in 2006, followed by the DOTS-Plus in 2007. However, with the phasing out of the specialized tuberculosis care system and the declining incidence, clinical workers in Taiwan might become less familiar with the presentation of tuberculosis. Complementing the patient-pathway analysis with health system delay estimates, the objective of this study is twofold: to estimate the alignment between patient care initiation and the availability of prompt diagnostic and treatment services, and to identify the risk factors of delayed tuberculosis treatment. Methods The study population included all Taiwanese patients with incident tuberculosis in 2013. We (1) identified 11,507 incident tuberculosis patients from the 2013 National TB Registry, and (2) linked 10,932 Taiwanese from the registry to the 2012–2013 National Health Insurance Research Database. We assessed patient’s care-seeking pathways and associated the determinants of health system delay in a Cox model. Results The overall health system delay was 46 days. We found that 20.5 and 3.5% of 10,932 tuberculosis patients were diagnosed and treated respectively at the initial visit to seek care for TB-related symptoms. Risk factors related to the prolonged health system delay included female gender (adjusted HR = 0.921, 95% CI: 0.884, 0.960), age > =65 years (adjusted HR = 0.720, 95% CI: 0.692, 0.750), non-severe (chest X-ray without cavities) (adjusted HR =0.721, 95% CI 0.683–0.760), chronic respiratory diseases (adjusted HR = 0.544, 95% CI: 0.522, 0.566), living in long-term care facilities (adjusted HR = 0.580, 95% CI: 0.525,0.640), an initial visit at a primary care clinic (adjusted HR = 0.588, 95% CI: 0.565, 0.612), and living in southern Taiwan (adjusted HR = 0.887, 95% CI: 0.798, 0.987). Conclusions The low access to TB diagnostic and treatment services at the initial visit and the prolonged health system delay indicate inefficiency in the health care system. Strengthening training of physicians at public hospitals and health workers at nursing homes might improve the efficiency and timeliness of tuberculosis diagnosis and treatment in Taiwan.

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Factors associated with patient and health care system delay in diagnosis for tuberculosis in the province of Luanda, Angola

BMC Infectious Diseases ◽

10.1186/1471-2334-13-168 ◽

2013 ◽

Vol 13 (1) ◽

Cited By ~ 22

Author(s):

Luigi Segagni Lusignani ◽

Gianluca Quaglio ◽

Andrea Atzori ◽

Joseph Nsuka ◽

Ross Grainger ◽

...

Keyword(s):

Health Care ◽

Health Care System ◽

System Delay ◽

Delay In Diagnosis ◽

Factors Associated ◽

Care System

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Diagnostic and treatment challenges of adolescent and young adult oncology patients.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.9557 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 9557-9557

Author(s):

Yanqing Xu ◽

Mauro Cardoso ◽

Michael Ostaric Palumbo ◽

Olivia Ishibashi ◽

Petr Kavan

Keyword(s):

Health Care ◽

Health Care System ◽

Symptom Onset ◽

Delay Time ◽

Treatment Delay ◽

Patient Delay ◽

Adolescent And Young Adult ◽

Diagnosis And Treatment ◽

System Delay ◽

Care System

9557 Background: Adolescent and young adult (AYA) cancer patients are faced with obstacles and challenges related to their diagnosis and treatment compared to children and older adults. The aim of this study was to explore the patient and health care system-related delays in the interval from cancer symptom onset to diagnosis and treatment as well as to identify the possible contributing factors to these delays in the AYA group. Methods: This study was based on a questionnaire conducted in 2010-2011 completed by patients diagnosed with a malignancy between the ages of 16 and 39 in addition to older patients diagnosed with a pediatric type malignancy. Four categories of delays: patient delay (time from patient symptom onset until first health care contact date), health care system delay (time from first health care contact until diagnosis date), treatment delay (time from diagnosis date until first treatment) and oncologist delay (time from first health care contact until first medical oncologist meeting) were calculated. Median delay (in days) with interquartile interval (IQI) was the main outcome measure. Median time for each category of delay was further analysed to explore how they vary with different patient characteristics. Results: We identified a median patient delay of 30 days (IQI 1-131), a median health care system delay of 53 days (IQI 1-213), a median treatment delay of 36 days (IQI 5-92) and a median oncologist delay of 77 days (IQI 30-281). Patient delay was affected by patient gender, age at diagnosis and type of first health care contact. Health care system delay was associated with patient marital status, financial situation and attitude of first health care professional. Treatment delay was related to type of cancer. Conclusions: The health care system delay (including oncologist delay) accounts for much of the delay from symptom onset to first treatment. Professional characteristics of frontline medical personnel as well as socioeconomic and biological characteristics of the patients may contribute to delay. Healthcare professionals and the general community as a whole need to be aware of the factors contributing to delay in diagnosis and treatment in the underserved patient population.

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Impact of Health Care System Delay in Patients With ST-Elevation Myocardial Infarction on Return to Labor Market and Work Retirement

The American Journal of Cardiology ◽

10.1016/j.amjcard.2014.09.018 ◽

2014 ◽

Vol 114 (12) ◽

pp. 1810-1816 ◽

Cited By ~ 14

Author(s):

Kristina Grønborg Laut ◽

Jacob Hjort ◽

Thomas Engstrøm ◽

Lisette Okkels Jensen ◽

Hans-Henrik Tilsted Hansen ◽

...

Keyword(s):

Myocardial Infarction ◽

Health Care ◽

Labor Market ◽

Health Care System ◽

St Elevation Myocardial Infarction ◽

System Delay ◽

St Elevation ◽

Care System

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Teletinnitus Program at the VA Gulf Coast Veterans Health Care System

Perspectives on Telepractice ◽

10.1044/teles4.1.23 ◽

2014 ◽

Vol 4 (1) ◽

pp. 23-29

Author(s):

Constance Hilory Tomberlin

Keyword(s):

Health Care ◽

Patient Satisfaction ◽

Patient Care ◽

Health Care System ◽

Gulf Coast ◽

New Technology ◽

Cost Effective ◽

Veterans Health ◽

Potential Benefits ◽

Care System

There are a multitude of reasons that a teletinnitus program can be beneficial, not only to the patients, but also within the hospital and audiology department. The ability to use technology for the purpose of tinnitus management allows for improved appointment access for all patients, especially those who live at a distance, has been shown to be more cost effective when the patients travel is otherwise monetarily compensated, and allows for multiple patient's to be seen in the same time slots, allowing for greater access to the clinic for the patients wishing to be seen in-house. There is also the patient's excitement in being part of a new technology-based program. The Gulf Coast Veterans Health Care System (GCVHCS) saw the potential benefits of incorporating a teletinnitus program and began implementation in 2013. There were a few hurdles to work through during the beginning organizational process and the initial execution of the program. Since the establishment of the Teletinnitus program, the GCVHCS has seen an enhancement in patient care, reduction in travel compensation, improvement in clinic utilization, clinic availability, the genuine excitement of the use of a new healthcare media amongst staff and patients, and overall patient satisfaction.

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