Comparing patient care seeking pathways in three models of hospital and TB programme collaboration in China

BMC Infectious Diseases

Qiang Sun¹  John Walley²  Jia Yin²  Guanyang Zou²  Xiaolin Wei³ 

[1] Center for Health Management and Policy, Shandong University, No 44 Wenhua Rd, Mailbox 128, Jinan, Shandong 250012, China;Nuffield Centre for International Health and Development, University of Leeds, 101 Clarendon Rd, LS2 9LJ, Leeds, UK;School of Public Health and Primary Care, The Chinese University of Hong Kong, 2/F, School of Public Health and Primary Care, Prince of Wales Hospital, Shatin, Hong Kong, N.T, China

关键词: China;    Hospital TB collaboration;    Care pathway;    Tuberculosis;   

Others  :  1171040
DOI  :  10.1186/1471-2334-13-93

 received in 2012-03-20, accepted in 2013-02-06,  发布年份 2013

【 摘 要 】

Background

Public hospitals in China play an important role in tuberculosis (TB) control. Three models of hospital and TB control exist in China. The dispensary model is the most common one in which a TB dispensary provides both clinical and public health care. The specialist model is similar to the former except that a specialist TB hospital is located in the same area. The specialist hospital should treat only complicated TB cases but it also treats simple cases in practice. The integrated model is a new development to integrate TB service in public hospitals. Patients were diagnosed, treated and followed up in this public hospital in this model while the TB dispensary provides public health service as case reporting and mass education. This study aims to compare patient care seeking pathways under the three models, and to provide policy recommendation for the TB control system reform in China.

Methods

Six sites, two in each model, were selected across four provinces, with 293 newly treated uncomplicated TB patients being randomly selected.

Results

The majority (68%) of TB patients were diagnosed in hospitals. Patients in the integrated model presented the simplest care seeking pathways, with the least number of providers visited (2.2), shortest treatment delays (2 days) and the least medical expenditure (2729RMB/401USD). On the contrary, patients in the specialist model had the highest number of provider visits (4), longest treatment delays (23 days) and the highest medical expenditure (11626RMB/1710USD). Logistic regression suggested that patients who were hospitalised tended to have longer treatment delays and higher medical expenditure.

Conclusion

Specialist hospital treating uncomplicated cases not using the standard regimens posed a threat to TB control. The integrated model has shortened patient treatment pathways, and reduced patient costs; therefore, it could be considered as the direction for future reform of China’s TB control system.

【 授权许可】

   
2013 Wei et al; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]WHO: WHO Report 2011:Global tuberculosis control. Geneva: WHO/HTM/TB/2011.16;
• [2]WHO: Public-Private Mix for DOTS: practical tools to help implementation. Geneva: World Health Organization.Stop TB Department; 2003.
• [3]WHO: Engaging all health care providers in TB control: guidance on implementing the public-priviate mix approaches. Gevena: World Health Organisation; 2006.
• [4]Chakaya J, Uplekar M, Mansoer J: Public-private mix for control of tuberculosis and TB-HIV in Nairobi, Kenya: outcomes, opportunities and obstacles. Int J Tuberc Lung Dis 2008, 12:1274-1278.
• [5]Newell JN, Pande SB, Baral C, Bam DS, Malla P: Control of tuberculosis in an urban setting in Nepal: public-private partnership. Bull World Health Organ 2004, 82:92-98.
• [6]Lonnroth K, Aung T, Maung W, Kluge H, Uplekar M: Social franchising of TB care through private GPs in Myanmar: an assessment of treatment results, access, equity and financial protection. Health Policy Plan 2007, 22:156-166.
• [7]Pantoja A, Lönnroth K, Lal SS: Economic evaluation of public-private mix for tuberculosis care and control, India. Part II. Cost and cost-effectiveness. Int J Tuberc Lung Dis 2009, 13:705-712.
• [8]Floyd K, Arora VK, Murthy KJ: Cost and cost-effectiveness of PPM-DOTS for tuberculosis control: evidence from India. Bull World Health Organ 2006, 84:437-445.
• [9]Pappa E, Niakas D: Assessment of health care needs and utilization in a mixed public-private system: the case of the Athens area. BMC Health Serv Res 2006, 2:146.
• [10]Ministry of Health: Operational Methods to Refer and Trace TB Cases. Beijing; 2005. http://www.moh.gov.cn/mohbgt/pw10505/200804/27314.shtml webcite
• [11]Long Q, Smith H, Zhang H, Tang S, Garner P: Patient medical costs for tuberculosis treatment and impact on adherence in China: a systematic review. BMC Publ Health 2011, 11:393. BioMed Central Full Text
• [12]National Technical Steering Group of the Epidemiological Sampling Survey: Report on fourth national epidemiological sampling survey of tuberculosis. Chin J Tuberc Respir Dis 2002, 25:3-7.
• [13]Ministry of Health: General report. In Social evaluation report of China TB control: 2004–2005. Edited by Disease Control Department. Beijing: China Union Medical University Press; 2006:3-76.
• [14]Wei X, Liang X, Walley J, Liu F, Dong B: Analysis of care-seeking pathways of tuberculosis patients in Guangxi, China, with and without decentralised tuberculosis services. Int J Tuberc Lung Dis 2009, 13:514-520.
• [15]Liu X, Thomson R, Gong Y: How affordable are tuberculosis diagnosis and treatment in rural China? An analysis from community and tuberculosis patient perspectives. Trop Med Int Health 2007, 12:1464-1471.
• [16]Long Q, Li Y, Wang Y: Barriers to accessing TB diagnosis for rural-to-urban migrants with chronic cough in Chongqing, China: a mixed methods study. BMC Health Serv Res 2008, 8:202. BioMed Central Full Text
• [17]Wang L, Liu J, Chin D: Progress in tuberculosis control and the evolving public-health system in China. Lancet 2007, 369:691-696.
• [18]Ministry of Health: Notice about Further Strengthening of TB Report and Patient Management. Beijing: Disease Control Department; 2004.
• [19]Zou G, Wei X, Walley J, Yin J, Sun Q: Factors influencing integration of TB services in general hospitals in two regions of China: a qualitative study. BMC Health Serv Res 2012, 12:21. BioMed Central Full Text
• [20]China National Centre for TB Control and Prevention: [China Tuberculosis Prevention and Control Plan: guideline for programme planning and implementation]. 2nd edition. Beijing: China Ministry of Health; 2008.
• [21]Sun Q, Meng QY, Yip W, Yin X, Li H: DOT in rural China: experience from a case study in Shandong Province, China. Int J Tuberc Lung Dis 2008, 12:625-630.
• [22]Yan F, Thomson R, Tang S: Multiple perspectives on diagnosis delay for tuberculosis from key stakeholders in poor rural China: case study in four provinces. Health Policy 2007, 82:186-199.
• [23]Tang S, Squire S: What lessons can be drawn from tuberculosis control in China in the 1990’s? An analysis from a health system perspective. Health Policy 2005, 72:93-104.
• [24]Wei X, Chen J, Chen P: Barriers to TB care for rural-to-urban migrant TB patients in Shanghai: a qualitative study. Trop Med Int Health 2009, 14:754-760.
• [25]Wang L, Liu X, Huang F, Hennig C, Uplekar M, Jiang S: Engaging hospitals to meet tuberculosis control targets in China: using the Internet as a tool to put policy into practice. Bull World Health Organ 2010, 88:937-942.
• [26]Singh AA, Frieden TR, Khatri GR, Garg R: A survey of tuberculosis hospitals in India. The. Int J Tuberc Lung Dis 2004, 8:1255-1259.
• [27]Probandari A, Lindholm L, Stenlund H, Utarini A, Hurtig AK: Missed opportunity for standardized diagnosis and treatment among adult tuberculosis patients in hospitals involved in Public-Private Mix for Directly Observed Treatment Short-Course strategy in Indonesia: a cross-sectional study. BMC Health Serv Res 2010, 10:113. BioMed Central Full Text
• [28]Chiang C, Trébucq A, Billo N: A survey of TB services in hospitals in seven large cities in Asia and North Africa. Int J Tuberc Lung Dis 2007, 11:739-746.
• [29]Gandhi NR, Nunn P, Dheda K: Multidrug-resistant and extensively drug-resistant tuberculosis: a threat to global control of tuberculosis. Lancet 2010, 375:1830-1843.
• [30]Zhang T, Tang S, Gao J, Whitehead M: Persistent problems of access to appropriate, affordable TB services in rural China: experiences of different social-economic groups. BMC Publ Health 2007, 7. BioMed Central Full Text
• [31]Uplekar M: Stopping tuberculosis: time to turn urgent attention to hospitals. Int J Tuberc Lung Dis 2008, 12:986.
• [32]Xu B, Jiang QW, Xiu Y, Diwan VK: Diagnostic delays in access to tuberculosis care in counties with or without the National Tuberculosis Control Programme in rural China. Int J Tuberc Lung Dis 2005, 9:784-790.
• [33]Wei X, Liang X, Liu F, Walley J, Dong B: Decentralising tuberculosis services from county tuberculosis dispensaries to township hospitals in China: an intervention study. Int J Tuberc Lung Dis 2008, 12:538-547.