"They know, they agree, but they don't do"--the paradox of tuberculosis case notification by private practitioners in Alappuzha district, Kerala, India

• Published in: PloS one Vol. 10; no. 4; p. e0123286
• Main Authors: Philip, Sairu, Isaakidis, Petros, Sagili, Karuna D, Meharunnisa, Asanarupillai, Mrithyunjayan, Sunilkumar, Kumar, Ajay M V
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 24.04.2015; Public Library of Science (PLoS)
• Subjects: Adult; Aged; Comparative analysis; Cross-Sectional Studies; Disease Notification - statistics & numerical data; Female; General Practitioners - statistics & numerical data; Humans; India; Male; Medical diagnosis; Medical personnel; Middle Aged; Private Practice - statistics & numerical data; Private sector; Professional Competence; Public health; Public sector; Qualitative Research; Surveys; Surveys and Questionnaires; Tuberculosis; Tuberculosis - epidemiology; Young Adult; India; Kerala India
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0123286

Despite being a recognized standard of tuberculosis (TB) care internationally, mandatory TB case notification brings forth challenges from the private sector. Only three TB cases were notified in 2013 by private practitioners compared to 2000 TB cases notified yearly from the public sector in Alappuzha district. The study objective was to explore the knowledge, opinion and barriers regarding TB Notification among private practitioners offering TB services in Alappuzha, Kerala state, India. This was a mixed-methods study with quantitative (survey) and qualitative components conducted between December 2013 and July 2014. The survey, using a structured questionnaire, among 169 private practitioners revealed that 88% were aware of mandatory notification. All patient-related details requested in the notification form (except government-issued identification number) were perceived to be important and easy to provide by more than 80% of practitioners. While more than 95% felt that notification should be mandatory, punitive action in case of failure to notify was considered unnecessary by almost two third. General practitioners (98%) were more likely to be aware of notification than specialists (84 %). (P<0.01). Qualitative purposive personal interviews (n=34) were carried out among private practitioners and public health providers. On thematic framework analysis of the responses, barriers to TB notification were grouped into three themes: 'private provider misconceptions about notification', 'patient confidentiality, and stigma and discrimination 'and 'lack of cohesion and coordination between public and private sector'. Private practitioners did not consider it necessary to notify TB cases treated with daily regimen. Communication strategies like training, timely dissemination of information of policy changes and one-to-one dialogue with private practitioners to dispel misconceptions may enhance TB notification. Trust building strategies like providing feedback about referred cases from private sector, health personnel visit or a liaison private doctor may ensure compliance to public health activities.