Tuberculosis management practices of private practitioners in Pune municipal corporation, India

• Published in: PloS one Vol. 9; no. 6; p. e97993
• Main Authors: Bharaswadkar, Sandeep, Kanchar, Avinash, Thakur, Narendra, Shah, Shubhangi, Patnaik, Brinda, Click, Eleanor S, Kumar, Ajay M V, Dewan, Puneet Kumar
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 04.06.2014; Public Library of Science (PLoS)
• Subjects: Collaboration; Confidence intervals; Cross-Sectional Studies; Diagnosis; Diagnostic systems; Disease control; Disease Management; Health care; Health Care Surveys; Health services; Humans; India; International standardization; International standards; Lung diseases; Management; Medical diagnosis; Medicine and Health Sciences; Microscopy; Participation; Patients; Physicians; Practice Patterns, Physicians' - standards; Private Practice - standards; Quality of Health Care - standards; Questionnaires; R&D; Research & development; Research and Analysis Methods; Serological tests; Serology; Studies; Training; Tuberculosis; Tuberculosis - diagnosis; Tuberculosis - drug therapy; Urban areas; India; Atlanta Georgia; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0097993

Private Practitioners (PP) are the primary source of health care for patients in India. Limited representative information is available on TB management practices of Indian PP or on the efficacy of India's Revised National Tuberculosis Control Programme (RNTCP) to improve the quality of TB management through training of PP. We conducted a cross-sectional survey of a systematic random sample of PP in one urban area in Western India (Pune, Maharashtra). We presented sample clinical vignettes and determined the proportions of PPs who reported practices consistent with International Standards of TB Care (ISTC). We examined the association between RNTCP training and adherence to ISTC by calculating odds ratios and 95% confidence intervals. Of 3,391 PP practicing allopathic medicine, 249 were interviewed. Of these, 55% had been exposed to RNTCP. For new pulmonary TB patients, 63% (158/249) of provider responses were consistent with ISTC diagnostic practices, and 34% (84/249) of responses were consistent with ISTC treatment practices. However, 48% (120/249) PP also reported use of serological tests for TB diagnosis. In the new TB case vignette, 38% (94/249) PP reported use of at least one second line anti-TB drug in the treatment regimen. RNTCP training was not associated with diagnostic or treatment practices. In Pune, India, despite a decade of training activities by the RNTCP, high proportions of providers resorted to TB serology for diagnosis and second-line anti-TB drug use in new TB patients. Efforts to achieve universal access to quality TB management must account for the low quality of care by PP and the lack of demonstrated effect of current training efforts.