scholarly journals Comparison of Delay in Tuberculosis Diagnosis Between Migrants and Local Residents in an Eastern County of China: An Analysis of the Electronic Data Between 2015 and 2019

2021 ◽  
Vol 9 ◽  
Author(s):  
Wenhui Xiao ◽  
Bin Chen ◽  
Dajiang Huang ◽  
Olivia Chan ◽  
Xiaolin Wei ◽  
...  
Keyword(s):  
Health System ◽  
Diagnostic Delay ◽  
Information Management System ◽  
Evidence Base ◽  
Patient Delay ◽  
Rank Test ◽  
Time Interval ◽  
System Delay ◽  
Early Screening ◽  
Health System Delay

Introduction: China continues to rank among one of the countries with the highest number of tuberculosis (TB) cases globally. Migrants are a particularly at-risk subgroup for TB and pose a challenge for case management in contemporary China. The early diagnosis and treatment of patients with TB are pivotal for effective TB control. This study investigates the delay in the TB diagnosis of migrants as compared with residents, to provide an evidence base for improved case detection and the better management of migrant patients with TB.Materials and Methods: The data was collected from the Tuberculosis Information Management System (TBIMS) (2015–2019) in an eastern county of China. The total diagnostic delay, consisting of patient delay and health system delay, is defined as the interval between the onset of TB symptoms and the confirmation of TB diagnosis in the designated TB hospital. The comparison of the delay in the TB diagnosis between migrants and residents was conducted using a Mann-Whitney U-test and chi-square test. The difference in the delay curves between these two groups was examined using a log-rank test.Results: Of 2,487 patients with TB, 539 (22%) were migrants. The migrants tended to be younger, presented with less severe conditions, received an initial diagnosis at prefectural and above-level hospitals. Compared with the local patients with TB, the migrant patients with TB had a longer median total diagnostic delay (30 vs. 9, P = 0.000) and a higher proportion of patients with this delay >28 days (52 vs. 13%, P = 0.000). Similarly, the migrant patients with TB also had a longer median patient delay (13 vs. 9, P = 0.000) and a higher proportion of patients with this delay >14 days (47 vs. 30%, P = 0.000), longer median health system delay (9 vs. 0, P = 0.000), and a higher proportion of patients with this delay >14 days (42 vs. 0.5%, P = 0.000) than the local patients with TB. The survival curves of delay showed that the longer the time interval was, the more likely the migrant patients with TB were to be diagnosed (P < 0.05).Conclusions: Diagnosis is significantly delayed among migrant patients with TB. Our study highlights the importance of early screening and diagnosis for TB especially among migrants, to improve access and ensure better management for all patients with TB.

scholarly journals Tuberculosis’ Total Health care system and patient side diagnosis and Treatment Delay and Associated Factors Among Pulmonary Tuberculosis Patients At Hadiya Zone Public Health Facilities, Southern Ethiopia.

2019 ◽  
Vol 9 (1-s) ◽  
pp. 214-228
Author(s):  
Gedeyon Getahun ◽  
Tilahun Beyene ◽  
Lakew Abebe
Keyword(s):  
Health Care ◽  
Health System ◽  
Treatment Delay ◽  
Health Facilities ◽  
Patient Delay ◽  
System Delay ◽  
Total Delay ◽  
Health System Delay ◽  
Tb Treatment ◽  
Hadiya Zone

Background: Delay in TB treatment is significant to both disease prognoses at the individual level and within the community. Even though studies conducted in TB treatment delay there is result inconsistencies due to differences in culture, environment and infrastructure. Objective: the aim of the study is to assess the tuberculosis treatment Delay and associated factor among pulmonary tuberculosis patients. Method: Facility based cross sectional study triangulated by Qualitative study was employed on 340 PTB patients in Hadiya zone public health facilities. Three woredas and health facilities were selected by Simple random sampling method. DOTS user at the beginning of data collection was consecutively recruited in to the study until the intended sample size was fulfilled. Multivariable binary Logistic regression was used. A P-value < 0.05 at 95 % CI was considered statistical significance between dependent and predictors variables. Result: Among 340 PTB patients enrolled in the study, of which 49.1% experienced patient delay, 30% health system delay and 49.8% total delay. Unable to read and write, Poor knowledge of TB (AOR 3.96, 95% CI (2.28   6.86), self-treatment (AOR: 2, 95% CI (1.14, 3.93), financial constraint (AOR: 2.092, 95% CI (1.11, 3.945) , Visiting two or more health care providers (AOR: 3.40, 95% CI (1.910 – 6.07), prolonged referral (AOR: 3.004, 95% CI (1.59, 5.67) were independent predictors of delay. Conclusion: Nearly half of the total delay was contributed by patient delay. Unable to read and write, Poor knowledge of TB, self-treatment, financial constraints, prolonged referral, several visit of health care provider of two or more and ever used other drugs rather than Anti-TB drugs were found to have association with patient delay and health system delay. Keywords: Tuberculosis treatment delay, PTB, patient delay and health system delay, Hadiya zone, Ethiopia.

scholarly journals Delayed diagnosis of tuberculosis in patients with diabetes mellitus co-morbidity and its associated factors in Zhejiang Province, China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wenhui Xiao ◽  
Dajiang Huang ◽  
Saiqiong Li ◽  
Shangcheng Zhou ◽  
Xiaolin Wei ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Regression Analysis ◽  
Health System ◽  
Multivariate Regression ◽  
Diagnostic Delay ◽  
Delayed Diagnosis ◽  
Multivariate Regression Analysis ◽  
System Delay ◽  
Health System Delay ◽  
Co Morbidity

Abstract Background Tuberculosis (TB) remains a significant global public health problem. China has the second highest TB burden in the world. With a growing TB population with diabetes mellitus (DM), the TB control system faces mounting challenges. To date, evidence remains inconclusive regarding the association between TB-DM co-morbidity and delayed diagnosis of TB patients. This study aims to assess the diagnostic delay of TB patients with known DM and identify the factors associated with this delay. Methods Data was collected from China’s Tuberculosis information management system in two counties of Zhejiang province, China. Patient delay, health system delay and total diagnostic delay are defined as follows: 1) the interval between the onset of TB symptoms and first visit to any health facility; 2) from the first visit to the health facility to the confirmed TB diagnosis in the designated hospital; 3) the sum of patient and health system’s respective delays. Comparison of these delays was made between TB patients with and without DM using Mann-Whitney U test and Chi-square test. Univariate and multivariate regression analysis was used to identify factors influencing delays among TB patients with DM. Results Of 969 TB patients, 67 (7%) TB patients had DM co-morbidity. Compared with TB patients without DM, TB patients with DM experienced significantly shorter health system delays (p < 0.05), and there was a significantly lower proportion of patients whose health system delayed> 14 days (7.0% vs. 18%, p < 0.05). However, no significant difference was observed between both patient categories regarding patient delay and total diagnostic delay. The multivariate regression analysis suggested that TB patients with DM who were aged < 60 years (AOR = 3.424, 95%CI: 1.008–11.627, p < 0.05) and non-severe cases (AOR = 9.725, 95%CI: 2.582–36.626, p < 0.05) were more likely to have a total diagnostic delay of> 14 days. Conclusions Our study suggests that DM does not contribute to further diagnostic delay as expected. Instead, we observed significantly improved health system delay among TB patients with DM. The findings indicate the importance of early screening and diagnosis for TB among diabetic patients and of strengthening the integrated control and management of TB and diabetic programs.

scholarly journals Patient and health system delays among tuberculosis patients attending DOTS centres of Kamrup (metro) district, Assam

2017 ◽  
Vol 4 (6) ◽  
pp. 1961
Author(s):  
Abhishek Gope ◽  
Kanika K. Baruah ◽  
Jutika Ojah ◽  
Rupali Baruah
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Care Providers ◽  
Patient Delay ◽  
Effective Control ◽  
Care Providers ◽  
System Delay ◽  
Health System Delay ◽  
The Mean ◽  
Formal Health Care

Background: Among the North eastern states, Assam has the highest burden of tuberculosis. Early diagnosis and prompt treatment is essential for effective control of tuberculosis.Methods: A cross sectional study was conducted among new smear positive tuberculosis cases above 15 years in Kamrup (Metrolpolitan) district of Assam from August 2015 to July 2016.Results: The mean patient delay was 34.2 days and the mean health system delay was 30.34 days. Female gender and patients who made first contact with non-formal health care providers were significantly associated with patient delay while illiteracy and age more than 35 years had significant association with health system delay.Conclusions: Median patient delay was found to be more than median health system delay. As patient delay was significantly associated with non-formal health care providers, the study proposes integration of non-formal health care providers with RNTCP which can reduce the patient delay. 

scholarly journals Facteurs De Retard Diagnostique De La Tuberculose Pulmonaire Vus À l’Unité De Soins, De Formation Et De Recherche De Pneumologie Befelatanana

2017 ◽  
Vol 13 (27) ◽  
pp. 413
Author(s):  
Ravahatra Kiady ◽  
Michel Tiaray Harison ◽  
Rakotondrabe Iantsotiana Davidson ◽  
Rasoafaranirina Marie Odette ◽  
Nandimbiniaina Anjara ◽  
...  
Keyword(s):  
Health System ◽  
Patient Delay ◽  
Diagnosis Delay ◽  
System Delay ◽  
Total Delay ◽  
Delay In Diagnosis ◽  
Health System Delay ◽  
Tuberculosis Diagnosis ◽  
Tuberculose Pulmonaire ◽  
A Prospective Study

Delay in diagnosis is significant to tuberculosis prognosis. The aim of this study is to evaluate the diagnosis delay of tuberculosis and to identify determinants of “patient delay”, “health system delay”, and “total delay” in the diagnosis of tuberculosis. It is a prospective study of the patients who were hospitalized at the Unité de Soins de Formation et de Recherche (USFR) of Pneumology in Befelatanana, Antananarivo Madagascar, during the period of 1 st October 2014 to 30 April 2015 (7 months). We included all patients with diagnosis of pulmonary tuberculosis. Sixty six patients were also included. The mean time of patient delay, health system delay, and total delay were 26,30± 36,87, 69,56±64, and 96,35±72,65 days respectively. The different variables that affected diagnosis delay were: tobacco smoke (OR : 3,6723), asthenia (OR : 5,4815), anorexia (OR : 2,9524), and hemoptysis (OR : 0,2406) for the total delay. Knowledge about tuberculosis signs (OR : 0,164) and transmissions (OR : 0,243) was for the patient delay. Hemoptysis (OR : 8,1250), asthenia (OR : 0,1081), breathlessness (OR : 0,3556), infiltrative syndrome (OR : 0,2500), and alveolar syndrome (OR : 0,0687) in chest Xray was for the health system delay. Having an understanding of these factors of tuberculosis diagnosis delay will result to a decrease in the diagnosis delay.

Diagnostic Pathways and Delays in Initiation of Treatment among Newly Diagnosed Tuberculosis Patients in Ballabgarh, India

2021 ◽  
Vol 104 (4) ◽  
pp. 1321-1325
Author(s):  
Ankit Chandra ◽  
Rakesh Kumar ◽  
Shashi Kant ◽  
Anand Krishnan
Keyword(s):  
Health System ◽  
Health Facility ◽  
Patient Delay ◽  
Newly Diagnosed ◽  
System Delay ◽  
Total Delay ◽  
Delay In Diagnosis ◽  
Health System Delay ◽  
Private Health Facility ◽  
Diagnostic Pathways

ABSTRACTA delay in diagnosis and initiation of treatment in patients with tuberculosis (TB) can affect the period of communicability and cost of treatment. We aimed to describe the diagnostic pathways and delays in initiation of treatment among drug-sensitive newly diagnosed TB patients in Ballabgarh, India. In May 2019, we interviewed 110 TB patients who were put on treatment in the past 2 months. It was a cross-sectional study where data collection was conducted by a physician. We used a structured questionnaire to collect the information on care-seeking practices, delays, and patient’s cost. Descriptive analysis was carried out for the pathways, delays, and patient cost. The mean number of health facility contacted before the diagnosis of TB was 2.8 (SD: 1.3); 76% of patients first sought care at a private health facility. The median total delay was 34.5 (IQR: 21–60) days; median patient delay seven (IQR: 2–21) days, median health system delay 16 (IQR: 8–45) days, median diagnostic delay 32.5 (IQR: 18–57) days, and median treatment delay two (IQR: 1–3) days. Health system delay was 2.2 times longer than patient delay; the health system delay was primarily due to delay in diagnosis. Patients contacting private health facility first had 1.7 times total delay, 2.4 times longer health system delay, and 3.4 times of direct cost compared with patients contacting a public health facility first. Accelerated efforts are needed to achieve India’s target to eliminate TB by 2025.

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

scholarly journals The Care Pathway Delays of Cervical Cancer Patient in Morocco

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Hind Mimouni ◽  
Khalid Hassouni ◽  
Boujemaa El Marnissi ◽  
Bouchra Haddou Rahou ◽  
Leila Alaoui ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Health System ◽  
Cancer Care ◽  
Care Pathway ◽  
Diagnostic Delay ◽  
Patient Delay ◽  
University Hospital ◽  
Cervical Cancer Patient ◽  
Diagnosis Delay ◽  
Time Intervals

Introduction. The aim of this study is to document time intervals in cervical cancer care pathways, from symptom onset to disease detection and start of treatment, and evaluate how clinical, sociodemographic, and treatment factors influence delays throughout a patient’s clinical pathway. Methods. A retrospective study was conducted at the FEZ Oncology Hospital of the Hassan II University Hospital Center in Morocco. Results. 190 medical records of cervical cancer patients were collected. The dominant age group was 35–44, the median patient delay (PD) was 6 days, the median healthcare provider’s delay (HCP) was 21 days, the median referral delay (RD) was 17 days, the median diagnostic delay (DD) was 9.5 days, the median total diagnostic delay (TDD) was 16 days, the median treatment delay (TD) was 67 days, and the median health system interval (HSI) was 92 days. Multivariate analysis revealed that age was associated with the patient delay, the healthcare provider’s delay, the diagnosis delay, and the health system interval. The diagnosis year (the year in which the patient was diagnosed (either before 2012 or during 2012 as well as the other study years (from 2013 to 2017))), all investigations done prior to admission to the oncology hospital, and the age of first sexual activity were significantly associated with healthcare provider’s delay. Conclusion. The integration of a model and standard care pathway into the Moroccan health system is essential in order to unify cervical cancer care in the country.

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.

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.

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