Whole-course quality of tuberculosis (TB) care in rural China: a retrospective study based on chart abstraction

• Published in: BMJ open Vol. 14; no. 5; p. e080844
• Main Authors: Li, Mingyue, Zhang, Xiaotian, Cheng, Haozhe, Zhang, Baisong, Wei, Tiantian, Cheng, Xiaoran, Jiang, Shiwen, Liu, Xiaoyun
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 31.05.2024; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Adolescent; Adult; Aged; Antitubercular Agents - therapeutic use; Chemotherapy; China; Chronic illnesses; Cohort analysis; Data collection; Disease control; Drug resistance; Female; health policy; Hospitals; Humans; Infectious Diseases; Male; Medical diagnosis; Medical laboratories; Medical Records; Middle Aged; Patients; primary health care; Quality of Health Care; Retrospective Studies; Rural areas; Rural Population; Tuberculosis; Tuberculosis - diagnosis; Tuberculosis - drug therapy; Tuberculosis - therapy; Young Adult; China; primary health care; health policy; tuberculosis
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2023-080844

ObjectivesThe aim of this study was to assess the quality of tuberculosis (TB) care for the whole course and assess factors that affect completing treatment.DesignThis is an observational retrospective study using chart abstraction for the whole course of TB care conducted at two underserved provinces in China.SettingThe study was conducted from June 2021 to July 2021. All medical records (outpatient and inpatient) for the whole course (6–8 months) of patients with TB newly registered from July 2020 to December 2020 were reviewed and abstracted using predetermined checklists.ParticipantsA total of 268 outpatient medical records and 126 inpatient records were included.Primary and secondary outcome measuresThe primary outcome included diagnostic quality, treatment quality and management quality. The secondary outcome was completing treatment.ResultsFor diagnostic quality, 94.2% of the diagnosis were based on adequate evidence. For treatment quality, 240 (91.6%) outpatients and 100 (85.5%) inpatients took the standard chemotherapy regimens. 234 (87.3%) patients completed treatment. 85.1% of the inpatients prescribed with second-line drugs were inappropriate. For management quality, 128 (47.9%) patients received midterm assessments, but only 47 (19.7%) received sufficient services for the whole course. Patients with TB symptoms were 1.8 times more likely to complete treatment (p=0.011).ConclusionPatients with TB received high-quality diagnosis and treatment services, but low-quality whole-course management. Integration of medical and public health services should be strengthened to improve whole-course quality.