Abstract
Background
Limitations of tuberculosis (TB) diagnostic tools and measures restrict proper TB control in places with high drug-resistant TB prevalence. This study aimed to explore gaps in the primary health care (PHC) TB services in Armenia compared to international standards on Assessment of Patients (AOP).
Methods
We applied mixed methods to assess the AOP standards in 30 outpatient TB centers using observational and documents/medical records review's standardized checklists, in-depth interviews, and focus group discussions. Evaluation was conducted in all 10 regions of Armenia and the capital city Yerevan. Joint Commission International Standards for Ambulatory Care, International Standards for TB Care, and WHO framework, served as a guideline for this assessment.
Results
PHC physicians are qualified for a set of examinations to diagnose TB. Planned reassessments are conducted continuously, though defined writings for the scope and content of reassessments administered by each clinical discipline is absent. Laboratory departments provide high quality services to the TB patients with the defined timeframes for reporting the results. Laboratory and radiology services staff is qualified and experienced. The biosafety rules are compliant with local and international standards. However, the location and conditions of the laboratory departments are mostly non-compliant with the standards. Lack of modern equipment restricts maintaining proper environmental controls, including ventilation systems. Laboratory technicians have little knowledge of the organization's safety management program and its relation to the laboratory safety program. The facilities have neither formal quality control programs regulated by documents and policies nor an identified radiation safety program protocol.
Conclusions
On the level of AOP standards, the PHC TB services in Armenia have satisfactory performance. However, assessed standards for this function required certain improvements.
Key messages
In Armenia, the tuberculosis care in PHC facilities presents high level of compliance for patient assessment international standards. To fully meet the standards, facilities need to reconstructed/renovated laboratories and establish the radiology and diagnostic equipment management, quality control and radiation safety programs.
Challenges in meeting patient assessment international standards in ambulatory tuberculosis services