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How did the TB patients reach DOTS services in Delhi? A study of patient treatment seeking behavior.

Kapoor SK, Raman AV, Sachdeva KS, Satyanarayana S - PLoS ONE (2012)

Bottom Line: The study showed that informal providers and retail chemists were the first point of contact and source of clinical advice for two-third of the patients, while the rest sought medical care from qualified providers directly.Most patients sought medical care from more than two providers, before being diagnosed as TB.Female TB patients and patients with extra-pulmonary TB had long mean duration between onset of symptoms to initiation of treatment (6.3 months and 8.4 months respectively).

View Article: PubMed Central - PubMed

Affiliation: Harrow Medical Centre, Noida, India. sunil_kapoor96@yahoo.com

ABSTRACT

Setting: Revised National Tuberculosis Control Programme (RNTCP), Delhi, India.

Objective: To ascertain the number and sequence of providers visited by TB patients before availing treatment services from DOTS; to describe the duration between onset of symptoms to treatment.

Study design: A cross sectional, qualitative study. Information was gathered through in-depth interviews of TB patients registered during the month of Oct, 2012 for availing TB treatment under the Revised National TB Control Programme from four tuberculosis diagnosis and treatment centers in Delhi.

Results: Out of the 114 patients who registered, 108 participated in the study. The study showed that informal providers and retail chemists were the first point of contact and source of clinical advice for two-third of the patients, while the rest sought medical care from qualified providers directly. Most patients sought medical care from more than two providers, before being diagnosed as TB. Female TB patients and patients with extra-pulmonary TB had long mean duration between onset of symptoms to initiation of treatment (6.3 months and 8.4 months respectively).

Conclusion: The pathways followed by TB patients, illustrated in this study, provide valuable lessons on the importance of different types of providers (both formal and informal) in the health system in a society like India and the delays in the diagnosis and treatment of tuberculosis.

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Related in: MedlinePlus

Pathways undertaken by the patients to reach the RNTCP (DOTS) Facilities, Delhi, India.
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pone-0042458-g001: Pathways undertaken by the patients to reach the RNTCP (DOTS) Facilities, Delhi, India.

Mentions: Figure 1 illustrates the pathways taken by the patients while seeking medical care from different providers. None of the patients had directly walked in to these centers seeking medical care. Nearly two thirds of the patients (n = 67) sought initial contact from informal providers as the first source of medical care, whereas less than one-third of patients (n = 33) sought services from qualified providers. The reason quoted by patients as to why they initially sought care from these informal providers is (translated into English) “we always go to Dr XX (also called locally as Bengali doctor) and recover quickly from our illnesses. He is wise and always has lot of patients in his clinic.” Not satisfied with the medical care from informal providers most (48 out of 67) then turn to qualified practitioners [patient quote “after taking medicines and injections for three weeks, I felt that this practitioner is not being able to diagnose my disease properly because he is not a qualified practitioner, so I went to a qualified (MBBS) practitioner”]. Some of those who sought services from informal providers (as the first source of medical care) also sought second opinion from either chemists or other informal providers repeatedly, before going to a qualified practitioner [the reason why chemists were visited in patient quote “these doctors charge a lot. Since all prescriptions go to a chemist, they know everything about the disease. Besides they do not charge any consultation fee. They (the chemists) have been serving our purpose well”]. Even after seeking medical care from qualified practitioner, some (n = 8) went back to informal providers. Almost all patients (n = 103) finally sought medical care from qualified practitioners, most of whom were in the private sector, before being referred to a DOTS center.


How did the TB patients reach DOTS services in Delhi? A study of patient treatment seeking behavior.

Kapoor SK, Raman AV, Sachdeva KS, Satyanarayana S - PLoS ONE (2012)

Pathways undertaken by the patients to reach the RNTCP (DOTS) Facilities, Delhi, India.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3412865&req=5

pone-0042458-g001: Pathways undertaken by the patients to reach the RNTCP (DOTS) Facilities, Delhi, India.
Mentions: Figure 1 illustrates the pathways taken by the patients while seeking medical care from different providers. None of the patients had directly walked in to these centers seeking medical care. Nearly two thirds of the patients (n = 67) sought initial contact from informal providers as the first source of medical care, whereas less than one-third of patients (n = 33) sought services from qualified providers. The reason quoted by patients as to why they initially sought care from these informal providers is (translated into English) “we always go to Dr XX (also called locally as Bengali doctor) and recover quickly from our illnesses. He is wise and always has lot of patients in his clinic.” Not satisfied with the medical care from informal providers most (48 out of 67) then turn to qualified practitioners [patient quote “after taking medicines and injections for three weeks, I felt that this practitioner is not being able to diagnose my disease properly because he is not a qualified practitioner, so I went to a qualified (MBBS) practitioner”]. Some of those who sought services from informal providers (as the first source of medical care) also sought second opinion from either chemists or other informal providers repeatedly, before going to a qualified practitioner [the reason why chemists were visited in patient quote “these doctors charge a lot. Since all prescriptions go to a chemist, they know everything about the disease. Besides they do not charge any consultation fee. They (the chemists) have been serving our purpose well”]. Even after seeking medical care from qualified practitioner, some (n = 8) went back to informal providers. Almost all patients (n = 103) finally sought medical care from qualified practitioners, most of whom were in the private sector, before being referred to a DOTS center.

Bottom Line: The study showed that informal providers and retail chemists were the first point of contact and source of clinical advice for two-third of the patients, while the rest sought medical care from qualified providers directly.Most patients sought medical care from more than two providers, before being diagnosed as TB.Female TB patients and patients with extra-pulmonary TB had long mean duration between onset of symptoms to initiation of treatment (6.3 months and 8.4 months respectively).

View Article: PubMed Central - PubMed

Affiliation: Harrow Medical Centre, Noida, India. sunil_kapoor96@yahoo.com

ABSTRACT

Setting: Revised National Tuberculosis Control Programme (RNTCP), Delhi, India.

Objective: To ascertain the number and sequence of providers visited by TB patients before availing treatment services from DOTS; to describe the duration between onset of symptoms to treatment.

Study design: A cross sectional, qualitative study. Information was gathered through in-depth interviews of TB patients registered during the month of Oct, 2012 for availing TB treatment under the Revised National TB Control Programme from four tuberculosis diagnosis and treatment centers in Delhi.

Results: Out of the 114 patients who registered, 108 participated in the study. The study showed that informal providers and retail chemists were the first point of contact and source of clinical advice for two-third of the patients, while the rest sought medical care from qualified providers directly. Most patients sought medical care from more than two providers, before being diagnosed as TB. Female TB patients and patients with extra-pulmonary TB had long mean duration between onset of symptoms to initiation of treatment (6.3 months and 8.4 months respectively).

Conclusion: The pathways followed by TB patients, illustrated in this study, provide valuable lessons on the importance of different types of providers (both formal and informal) in the health system in a society like India and the delays in the diagnosis and treatment of tuberculosis.

Show MeSH
Related in: MedlinePlus