Health system factors influencing management of multidrug-resistant tuberculosis in four European Union countries - learning from country experiences

BMC Public Health

Research Article

Daniela Schmid¹  Marieke J. van der Werf²  Vahur Hollo²  Svetla Tsolova²  Gerard de Vries³  Bert Schreuder³  Einar Heldal³  Agnes C. Gebhard³  Laura Sánchez-Cambronero Cejudo⁴  Tonka Varleva⁵  Laura F. Anderson⁶ 

[1] Austrian Agency for Health and Food Safety, Vienna, Austria;European Centre for Disease Prevention and Control, Tomtebodavagen 11A, S-171 83, Stockholm, Sweden;KNCV Tuberculosis Foundation, The Hague, The Netherlands;Ministry of Health, Social Services and Equality, Madrid, Spain;National Tuberculosis Programme, Sofia, Bulgaria;Public Health England Colindale, London, UK;

关键词: European Union;    Healthcare systems;    Multidrug-resistance;    Treatment outcome;    Tuberculosis;   

DOI  :  10.1186/s12889-017-4216-9

 received in 2015-08-20, accepted in 2017-04-01,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundIn the European Union and European Economic Area only 38% of multidrug-resistant tuberculosis patients notified in 2011 completed treatment successfully at 24 months’ evaluation. Socio-economic factors and patient factors such as demographic characteristics, behaviour and attitudes are associated with treatment outcomes. Characteristics of healthcare systems also affect health outcomes. This study was conducted to identify and better understand the contribution of health system components to successful treatment of multidrug-resistant tuberculosis.MethodsWe selected four European Union countries to provide for a broad range of geographical locations and levels of treatment success rates of the multidrug-resistant tuberculosis cohort in 2009. We conducted semi-structured interviews following a conceptual framework with representatives from policy and planning authorities, healthcare providers and civil society organisations. Responses were organised according to the six building blocks of the World Health Organization health systems framework.ResultsIn the four included countries, Austria, Bulgaria, Spain, and the United Kingdom, the following healthcare system factors were perceived as key to achieving good treatment results for patients with multidrug-resistant tuberculosis: timely diagnosis of drug-resistant tuberculosis; financial systems that ensure access to a full course of treatment and support for multidrug-resistant tuberculosis patients; patient-centred approaches with strong intersectoral collaboration that address patients’ emotional and social needs; motivated and dedicated healthcare workers with sufficient mandate and means to support patients; and cross-border management of multidrug-resistant tuberculosis to secure continuum of care between countries.ConclusionWe suggest that the following actions may improve the success of treatment for multidrug-resistant tuberculosis patients: deployment of rapid molecular diagnostic tests; development of context-specific treatment guidance and criteria for hospital admission and discharge in the European context; strengthening patient-centred approaches; development of collaborative mechanisms to ensure cross-border care, and development of long-term sustainable financing strategies.

【 授权许可】

CC BY   
© The Author(s). 2017