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

• Published in: The international journal of tuberculosis and lung disease Vol. 8; no. 2; pp. 180 - 185
• Main Authors: PAYNTER, S, HAYWARD, A, WILKINSON, P, LOZEWICZ, S, COKER, R
• Format: Journal Article
• Language: English
• Published: Paris, France IUATLD 01.02.2004; Union internationale contre la tuberculose et les maladies respiratoires
• Subjects: Adult; Bacterial diseases; Bacterial diseases of the respiratory system; Biological and medical sciences; Case Finding; Cohort Studies; Female; Health Services; Health Services Accessibility - organization & administration; Hospitals, University; Human bacterial diseases; Humans; Infectious diseases; London; Male; Medical sciences; Patient Acceptance of Health Care; Retrospective Studies; Risk Factors; Time Factors; Tuberculosis; Tuberculosis, Pulmonary - diagnosis; Tuberculosis, Pulmonary - therapy; London; Human; Lung disease; Respiratory disease; Pulmonary tuberculosis; tuberculosis; Health service; Mycobacterial infection; Delay; Retrospective; Infection; Case study; Treatment; Cohort study; health services; Bacteriosis; London; case finding
• ISSN: 1027-3719; 1815-7920

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.