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Free Content Factors related to health system delays in the diagnosis of pulmonary tuberculosis in Estonia

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OBJECTIVE: To estimate health system delays (HSD) in the diagnosis of pulmonary tuberculosis (PTB) and its risk factors after major social changes in Estonia, and to assess the ability of a completely reformed health care system to diagnose patients with PTB.

METHODS: All newly detected symptomatic culture-positive patients with PTB aged ≥16 years from Southern Estonia during 2002–2003 (n = 185) were interviewed. HSD was defined as the interval from a patient's first contact with a medical provider to the date of TB diagnosis.

RESULTS: The factors significantly associated with HSD greater than the median (19 days) and the 75th percentile (40 days) were smear negativity, absence of cough among symptoms, absence of chest X-ray during the first visit and age >60 years. A significantly shorter HSD was determined in non-Estonians and unemployed patients. HSD was not associated with the specialty of the doctor first contacted by the patient.

CONCLUSION: This study in Southern Estonia shows that the health care system is still managing the diagnosis of PTB without significant delays, even after substantial modifications in the health care system resulting from social reform in a post-socialist country, and that family physicians can manage PTB patients successfully.

Keywords: health system delay; pulmonary tuberculosis; risk factors

Document Type: Regular Paper

Affiliations: 1: Department of Pulmonary Medicine, University of Tartu, Tartu, Estonia 2: Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia; and Estonian Centre of Excellence in Behavioural and Health Sciences, Tartu-Tallinn, Estonia

Publication date: 2007-03-01

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  • 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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