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Free Content Patient and health care system delays in pulmonary tuberculosis diagnosis in a low-incidence state

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Abstract:

SETTING: Tuberculosis (TB) patients reported to the Maryland Department of Health and Mental Hygiene from 1 June 2000 to 30 November 2001.

OBJECTIVE: To determine the extent of delayed diagnosis of TB and to assess patient and provider factors associated with delays.

DESIGN: A prospective cohort study.

RESULTS: Median patient, health care and total delays were 32, 26 and 89 days, respectively, for 158 patients. Non-white (relative hazard [RH] 0.62; 95%CI 0.39–0.98) and less educated (RH 0.43; 95%CI 0.26–0.72) patients had longer patient delays. English-speaking patients (RH 0.40; 95%CI 0.24–0.68) had increased health care delays, as did patients who received a diagnosis of a respiratory illness and non-TB antibiotics (RH 0.69; 95%CI 0.49–0.96) prior to a TB diagnosis. Patients first presenting to a private physician (51 days) rather than a hospital emergency room (18 days; RH 1.87; 95%CI 1.05–3.33) or public health clinic (10 days; RH 1.79; 95%CI 1.21–2.63) had longer health care delays. When a TB diagnostic tool (chest radiograph or AFB culture) was utilized, a more rapid diagnosis of TB was made.

CONCLUSION: Education of the patient population about TB symptoms might reduce delays. Increased physician awareness of the current epidemiology of TB and better use of available diagnostic tools will reduce delays and may reduce TB transmission.

Keywords: delayed diagnosis; epidemiology; tuberculosis

Document Type: Regular Paper

Affiliations: 1: School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Maryland Department of Health and Mental Hygiene, Baltimore, Maryland, USA; and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA 2: Maryland Department of Health and Mental Hygiene, Baltimore, Maryland, USA 3: Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA 4: School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA

Publication date: 2005-09-01

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

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