Authors: L.F. Sherman¹; P.I. Fujiwara²; S.V. Cook¹; L.B. Bazerman¹; T.R. Frieden²

Source: The International Journal of Tuberculosis and Lung Disease, Volume 3, Number 12, December 1999 , pp. 1088-1095(8)

Publisher: International Union Against Tuberculosis and Lung Disease

Abstract:

SETTING: All culture-positive tuberculosis patients without previous treatment for tuberculosis (n = 184), New York City, April 1994.

OBJECTIVE: To examine factors associated with delays in presenting to a health care provider (patient delay) and in starting antituberculosis treatment (health care system delay).

DESIGN: Retrospective medical record review and patient interviews.

RESULTS: Median total delay was 57 days (range 4–764), 35 for acid-fast bacilli smear-positive patients and 79 for smear-negative patients (P < 0.001). Median patient delay was 25 (range 0–731). Median health care system delay was 15 days, 6 for smear-positive patients and 31 for smear-negative patients (P < 0.001). In logistic regression, age 55–64 years (adjusted odds ratio [OR_adj] 10.6, 95% confidence interval [CI] 1.3–86.9), and primary language other than English (OR_adj 2.5, 95%CI 1.0–5.8), were associated with longer patient delays. Homelessness (OR_adj 7.1, 95%CI 1.05–33.5), not having a chest radiograph at the first medical visit (OR_adj 2.4, 95%CI 1.0–5.4), negative smear (OR_adj 10.2, 95%CI 4.4–23.3) and absence of cough (OR_adj 2.9, 95%CI 1.2–6.8) were associated with longer health care system delays.

CONCLUSION: To reduce delays, patients should be educated to seek care more quickly, and should be provided with culturally appropriate health care and language services. Physicians should maintain a high index of suspicion for tuberculosis and perform appropriate diagnostic tests.

Keywords: tuberculosis; diagnostic delays; patient delay; health care system delay; diagnosis

Document Type: Regular paper

Affiliations: 1: Bureau of Tuberculosis Control, New York City Department of Health, New York, New York, USA 2: Bureau of Tuberculosis Control, New York City Department of Health, New York, New York, USA; and Division of Tuberculosis Elimination, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia,

Publication date: 1999-12-01

More about this publication?

• The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

  Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

• Editorial Board
• Information for Authors
• Subscribe to this Title
• ingentaconnect is not responsible for the content or availability of external websites

Related content

• In this: publication
• By this: publisher
• In this Subject: Internal Medicine
• By this author: L.F. Sherman ;  P.I. Fujiwara ;  S.V. Cook ;  L.B. Bazerman ;  T.R. Frieden

Website © Publishing Technology. Article copyright remains with the publisher, society or author(s) as specified within the article.

• Terms and conditions
• Privacy policy
• Information for advertisers