Delay and discontinuity—a survey of TB patients' search of a diagnosis in a diversified health care system
OBJECTIVES: To describe delay to diagnosis; to compare diagnostic procedures and referral routines used by private and public health care providers; and to examine associations between contact with various types of providers and risk of delay to TB diagnosis.
DESIGN: Cross-sectional survey of new patients in the National Tuberculosis Programme (NTP). Retrospective assessment of health seeking and diagnostic procedures used by previously contacted health care providers.
RESULTS: Four weeks after first symptom, 81% of patients had sought help outside the household. Four weeks after first health care contact, 47% had been diagnosed with TB. Private physicians used X-rays, sputum smears, and referrals significantly less often than public health care providers. Patients who had turned first to a private pharmacy, a private physician or a public hospital were significantly more likely to have a long provider delay than those who turned first to the NTP.
CONCLUSION: Delay to diagnosis of TB in HCMC is due more to inability among health care providers to detect TB than to under-utilisation of health care services. Diagnostic procedures need to be improved and referral chains need to be strengthened in HCMC, particularly among private providers.
Document Type: Regular Paper
Affiliations: 1: Department of Social Medicine, Göteborg University, Göteborg, Sweden; and Nordic School of Public Health, Göteborg, Sweden 2: Pham Ngoc Thach TB and Lung Disease Center, Ho Chi Minh City, Vietnam 3: Nordic School of Public Health, Göteborg, Sweden; and Division of International Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
Publication date: 01 November 1999
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