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Free Content Patient and health service delays in initiating treatment for patients with pulmonary tuberculosis: retrospective cohort study

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SETTING: Catchment population of the North Middlesex University Hospital (NMUH), London, UK.

OBJECTIVE: To measure patient and health care delays in treatment of pulmonary tuberculosis.

DESIGN: Retrospective cohort study of patients notified with pulmonary tuberculosis between 1 April 2001 and 1 March 2002.

RESULTS: The median case finding delays were between 78 and 99 days. Median patient-related delay was between 34.5 and 54 days. Median health care-related delay was 29.5 days. Shorter case finding delays were found in patients born in a high prevalence country, patients presenting first to Accident and Emergency department (A&E), younger patients, and those with sputum smear-positive disease. In those presenting first to A&E, those born in a high prevalence country, and those with sputum-positive disease, this effect was predominantly due to shorter health care delays. Limitations of TB service capacity and organisational factors appeared responsible for up to half of the difference in delay between those presenting to A&E or general practitioners (GPs).

CONCLUSION: Patient and health service delays contribute substantially to delays in patients accessing treatment. Considerable reduction in case finding delays may be achieved through changes in the capacity of tuberculosis services, and coordination of associated health services.
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Keywords: London; case finding; health services; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK 2: UCL Centre for Infectious Disease Epidemiology, Royal Free and University College Medical Schools, Department of Primary Care and Population Sciences, Royal Free Campus, London, UK 3: Department of Respiratory Medicine, North Middlesex University Hospital, London, UK

Publication date: 01 February 2004

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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