scholarly journals Individual and public health consequences associated with a missed diagnosis of pulmonary tuberculosis in the emergency department: A retrospective cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248493
Author(s):  
Courtney Heffernan ◽  
Catherine Paulsen ◽  
Leyla Asadi ◽  
Mary-Lou Egedahl ◽  
Brian H. Rowe ◽  
...  
Keyword(s):  
Public Health ◽  
Emergency Department ◽  
Cohort Study ◽  
Pulmonary Tuberculosis ◽  
Health System ◽  
Discharge Diagnosis ◽  
Health Consequences ◽  
System Delay ◽  
Health System Delay ◽  
Missed Diagnosis

Objectives To determine: i) the emergency department (ED) utilization history of pulmonary tuberculosis (PTB) patients, and ii) the potential individual and public health consequences of a missed diagnosis of PTB in this setting. Design Retrospective observational cohort study. Participants Patients with PTB aged >16 years diagnosed between April 1, 2010 and December 31, 2016 in the Province of Alberta, Canada. Methods We identified valid new cases of PTB from a provincial registry and linked them to ED attendees in administrative databases. Visits are considered ‘PTB’, pulmonary ‘other’, and non-pulmonary based on the most responsible discharge diagnosis. Individual consequences of a missed diagnosis included health system delay and PTB-related death; public health consequences included nosocomial ED exposure time and secondary cases. Results Of 711 PTB patients, 378 (53%) made 845 ED visits in the six months immediately preceding the date of diagnosis. The most responsible ED discharge diagnosis was PTB in 92 (10.9%), pulmonary ‘other’ in 273 (32%) and non-pulmonary in 480 (56.8%). ED attendees had a median (IQR) health system delay of 27 (7,180) days and, compared to non-ED attendees were more likely to die a TB-related death 5.9% vs 1.2%, p = 0.001. Emergency attendees generated 3812 hours of ED nosocomial exposure time, and 31 secondary cases (60.8% of all secondary cases reported). Mycobacterium tuberculosis isolates from ED-attendees were more likely than non-attendees to be clustered–i.e., have an identical DNA fingerprint with another isolate (27% vs. 21%, p = 0.037). Conclusions ED utilization by PTB patients, and related consequences, are substantial. EDs are a potential resource for earlier PTB diagnosis.

scholarly journals Patient and health system delay among patients with pulmonary tuberculosis in Beira city, Mozambique

2013 ◽  
Vol 13 (1) ◽  
Author(s):  
Abuchahama Saifodine ◽  
Paula Samo Gudo ◽  
Mohsin Sidat ◽  
James Black
Keyword(s):  
Pulmonary Tuberculosis ◽  
Health System ◽  
System Delay ◽  
Health System Delay

Factors Associated With Health System Delay in Accessing Pulmonary Tuberculosis Care in Gezira State, Sudan

2013 ◽  
Vol 8 (2) ◽  
Author(s):  
Elsadig Mohamed ◽  
Khalid Madani ◽  
Sawsan Abdalla ◽  
Mohamed Ounsa ◽  
Hisham Abdelraheim
Keyword(s):  
Pulmonary Tuberculosis ◽  
Health System ◽  
System Delay ◽  
Factors Associated ◽  
Health System Delay ◽  
Tuberculosis Care

scholarly journals Determinants of health system delay among confirmed tuberculosis cases in Spain

2005 ◽  
Vol 15 (4) ◽  
pp. 343-349 ◽  
Author(s):  
M. Díez ◽  
M.J. Bleda ◽  
J. Alcaide ◽  
C. Castells ◽  
J.I. Cardenal ◽  
...  
Keyword(s):  
Health System ◽  
Determinants Of Health ◽  
System Delay ◽  
Health System Delay

Health System Response and Adaptation to the Largest Sandstorm in the Middle East

2016 ◽  
Vol 11 (2) ◽  
pp. 227-238 ◽  
Author(s):  
Furqan B. Irfan ◽  
Sameer A. Pathan ◽  
Zain A. Bhutta ◽  
Mohamed E. Abbasy ◽  
Amr Elmoheen ◽  
...  
Keyword(s):  
Public Health ◽  
Emergency Department ◽  
Particulate Matter ◽  
Middle East ◽  
Respiratory Distress ◽  
Health System ◽  
Disaster Management ◽  
Peak Load ◽  
Tertiary Hospital ◽  
System Response

AbstractThe State of Qatar experienced a sandstorm on the night of April 1, 2015, lasting approximately 12 hours, with winds of more than 100 km/h and average particulate matter of approximately 10 μm in diameter. The emergency department (ED) of the main tertiary hospital in Qatar managed 62% of the total emergency calls and those of higher triage order. The peak load of patients during the event manifested approximately 6 hours after the onset. The Major Emergency Command Centre of the hospital ensured the department was maximally organized in terms of disaster management, and established protocols were brought into action. Multiple timely meetings were convened in efforts to effectively execute plans that included rapid emergency medical services handover time, resourcing staff, maximizing bed space, preventing dust entry in the ED, bypassing certain administrative processes, canceling day-surgeries that did not affect inpatient morbidity, and procuring additional respiratory equipment. Patients arrived mainly with exacerbations of asthma and respiratory distress, ophthalmic emergencies, and vehicular trauma; surprisingly, the incidence of pedestrian injuries did not vary. (Disaster Med Public Health Preparedness. 2017;11:227–238)

scholarly journals The circuits of healthcare: Understanding healthcare seeking behaviour—A qualitative study with tuberculosis patients in Lisbon, Portugal

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261688
Author(s):  
Rafaela M. Ribeiro ◽  
Philip J. Havik ◽  
Isabel Craveiro
Keyword(s):  
Health System ◽  
Health Belief ◽  
System Delay ◽  
Structured Interviews ◽  
Tuberculosis Patients ◽  
Healthcare Seeking ◽  
Health System Delay ◽  
Services Delivery ◽  
Belief Model ◽  
Diagnostic Delays

Background Understanding health delivery service from a patient´s perspective, including factors influencing healthcare seeking behaviour, is crucial when treating diseases, particularly infectious ones, like tuberculosis. This study aims to trace and contextualise the trajectories patients pursued towards diagnosis and treatment, while discussing key factors associated with treatment delays. Tuberculosis patients’ pathways may serve as indicator of the difficulties the more vulnerable sections of society experience in obtaining adequate care. Methods We conducted 27 semi-structured interviews with tuberculosis patients attending a treatment centre in a suburban area of Lisbon. We invited nationals and migrant patients in active treatment to participate by sharing their illness experiences since the onset of symptoms until the present. The Health Belief Model was used as a reference framework to consolidate the qualitative findings. Results By inductive analysis of all interviews, we categorised participants’ healthcare seeking behaviour into 4 main types, related to the time participants took to actively search for healthcare (patient delay) and time the health system spent to diagnose and initiate treatment (health system delay). Each type of healthcare seeking behaviour identified (inhibited, timely, prolonged, and absent) expressed a mindset influencing the way participants sought healthcare. The emergency room was the main entry point where diagnostic care cascade was initiated. Primary Health Care was underused by participants. Conclusions The findings support that healthcare seeking behaviour is not homogeneous and influences diagnostic delays. If diagnostic delays are to be reduced, the identification of behavioural patterns should be considered when designing measures to improve health services’ delivery. Healthcare professionals should be sensitised and perform continuous capacity development training to deal with patients´ needs. Inhibited and prolonged healthcare seeking behaviour contributes significantly to diagnostic delays. These behaviours should be detected and reverted. Timely responses, from patients and the healthcare system, should be promoted.

Health system delay in the treatment of tuberculosis patients in Ethiopia: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Kenaw Tegegne ◽  
Fasil Wagnew ◽  
Yihalem Abebe Belay ◽  
Dawit Eyayu ◽  
Daniel Bekele
Keyword(s):  
Systematic Review ◽  
Health System ◽  
Median Time ◽  
Meta Analysis ◽  
A Priori ◽  
Rural Residence ◽  
System Delay ◽  
Tuberculosis Patients ◽  
Delay In Diagnosis ◽  
Health System Delay

Abstract Background: Delay in diagnosis and initiation of effective treatment associated with increase in morbidity, mortality and on-going person-to-person transmission in the community at large. In Ethiopia, several studies have been conducted regarding health system delay among tuberculosis patients. However, studies assessing the health system delay in treatment of tuberculosis patients in Ethiopia had inconsistent and inconclusive findings. Therefore, this systematic review and meta-analysis aimed to determine the pooled median time of the health system delay in the treatment of tuberculosis and its determinants in Ethiopia. Methods: We systematically searched from different databases: Google Scholar, Science Direct, PubMed, Embase, Scopus and Springer link databases for studies published from June 6, 1997 up to December 20, 2020. The quality of the studies was assessed using the Newcastle-Ottawa scale adapted for observational studies. Heterogeneity was evaluated using I squared statistic. We conducted a meta-analysis for the pooled median time of health system delay and its determinants using random-effects model in R version 4.0.3 software(for median estimation) and Stata version 14 (for metan). The pooled estimates with 95% confidence intervals (CI) were presented using forest plots. Results: A total of 14 studies which comprising 6161 patients satisfying a priori set criteria were included. Our meta-analysis showed that, the estimated pooled median time of the health system delay was 15.29(95%CI: 9.94–20.64) days. In the subgroup analysis, studies conducted from 1997 to 2015 the pooled median health system delay was 21.63(95% CI: 14.38-28.88) days, whereas studies conducted after 2015 the pooled median time of 9.33(95% CI: 3.95-14.70) days. Living in rural area (pooled OR: 2.42, 95%CI: 1.16-5.02) was significantly associated with health system delay. Conclusions: In Ethiopia, patients are delayed more-than two weeks in the treatment of tuberculosis. Being from rural residence was more likely to lead prolonged health system delay. Implementing efforts by targeting rural residence may help to shorten the health system delay and important implications for the success of tuberculosis control.

Sign in / Sign up

Export Citation Format

Share Document