TY - JOUR
T1 - The road to tuberculosis treatment in rural Nepal
T2 - A qualitative assessment of 26 journeys
AU - Ten Asbroek, Augustinus H A
AU - Bijlsma, Merijn W
AU - Malla, Puspha
AU - Shrestha, Binjwala
AU - Delnoij, Diana M J
PY - 2008/1/11
Y1 - 2008/1/11
N2 - BACKGROUND: The fact that tuberculosis can be treated with the DOTS strategy (Directly Observed Treatment, Short-course) is not enough to control the disease. Patients have to find their way to tuberculosis treatment first. To better understand the route to tuberculosis treatment in rural Nepal we interviewed twenty-six patients under treatment.METHODS: In semi-structured interviews patients shared their disease history and health seeking behaviour. The analysis focused on the encounters with the health care system before enrolment in the tuberculosis treatment program.RESULTS: Patient routes often started in the medical shop and led via intricate routes with multiple providers to facilities with higher qualified and more competent staff where tuberculosis was diagnosed. Several factors influenced the route to tuberculosis treatment. Besides known patients factors (such as severity of complaints, the ability to pay for services, availability of services and peer support for choosing a provider) specific health services factors were also identified. These included the perceived quality, costs and service level of a provider, and lack of provider initiated referral. Self referral because of waned trust in the provider was very common. In contrast, once tuberculosis was considered a possible diagnosis, referral to diagnostic testing and tuberculosis treatment was prompt.CONCLUSION: Patient routes towards tuberculosis treatment are characterised by self referral and include both private and public health care providers. Once tuberculosis is suspected referral for diagnosis and treatment is prompt. Given the importance of the private practitioners in the patient routes, quality improvement initiatives need to address not only the public sector but the private health care sector as well.
AB - BACKGROUND: The fact that tuberculosis can be treated with the DOTS strategy (Directly Observed Treatment, Short-course) is not enough to control the disease. Patients have to find their way to tuberculosis treatment first. To better understand the route to tuberculosis treatment in rural Nepal we interviewed twenty-six patients under treatment.METHODS: In semi-structured interviews patients shared their disease history and health seeking behaviour. The analysis focused on the encounters with the health care system before enrolment in the tuberculosis treatment program.RESULTS: Patient routes often started in the medical shop and led via intricate routes with multiple providers to facilities with higher qualified and more competent staff where tuberculosis was diagnosed. Several factors influenced the route to tuberculosis treatment. Besides known patients factors (such as severity of complaints, the ability to pay for services, availability of services and peer support for choosing a provider) specific health services factors were also identified. These included the perceived quality, costs and service level of a provider, and lack of provider initiated referral. Self referral because of waned trust in the provider was very common. In contrast, once tuberculosis was considered a possible diagnosis, referral to diagnostic testing and tuberculosis treatment was prompt.CONCLUSION: Patient routes towards tuberculosis treatment are characterised by self referral and include both private and public health care providers. Once tuberculosis is suspected referral for diagnosis and treatment is prompt. Given the importance of the private practitioners in the patient routes, quality improvement initiatives need to address not only the public sector but the private health care sector as well.
KW - Adolescent
KW - Adult
KW - Aged
KW - Child
KW - Continuity of Patient Care
KW - Directly Observed Therapy/utilization
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Male
KW - Middle Aged
KW - Narration
KW - National Health Programs
KW - Nepal/epidemiology
KW - Patient Acceptance of Health Care/statistics & numerical data
KW - Private Practice/standards
KW - Process Assessment (Health Care)/methods
KW - Public Health Administration/standards
KW - Qualitative Research
KW - Referral and Consultation
KW - Rural Health Services/standards
KW - Tuberculosis, Pulmonary/epidemiology
U2 - 10.1186/1472-6963-8-7
DO - 10.1186/1472-6963-8-7
M3 - Article
C2 - 18190698
VL - 8
SP - 7
JO - BMC Health Services Research
JF - BMC Health Services Research
SN - 1472-6963
ER -