Document Detail

Multilevel factors affecting tuberculosis diagnosis and initial treatment.
MedLine Citation:
PMID:  18373583     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The study aims to assess provider adherence to national tuberculosis programme guidelines on diagnosis, initial regimens and dosages, and to examine independent effects of factors at patient, staff and hospital levels influencing adherence. METHODS: A review of 383 medical records of new tuberculosis (TB) patients and interviews with related staff were carried out. The study was conducted in 16 public hospitals of seven provinces of southern Thailand. The outcome variables were provider adherence to the guidelines on diagnostic procedure, initial regimen and dosage. Independent variables consisted of patient, staff and hospital factors. Multilevel logistic regression was used to identify factors associated with adherence. RESULTS: The proportions of adherence to the diagnostic procedure, initial regimen and initial dosage prescribed were 70.0%, 100.0% and 57.1%, respectively. Most of diagnosis non-adherence was anti-TB drugs being prescribed for smear-negative patients without prior antibiotic trial (12.5%). The anti-TB drug with the highest percentages of patients receiving non-adhered dosage was ethambutol (33.6%). In contrast to single-level analysis, which showed significant influence of up to five factors, multilevel analysis confirmed only strong effect of male patients receiving better adhered diagnosis and of non-doctors and TB clinics providing better dosage adherence. CONCLUSIONS: Adherence to TB diagnostic procedures was not good, and adherence to initial dosage, especially for ethambutol, was poor. TB clinics, the key factor of adherence, should be expanded. Female patients should be reviewed more carefully because they tend to receive poorer diagnosis adherence.
Wilawan Thongraung; Virasakdi Chongsuvivatwong; Petchawan Pungrassamee
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-03-24
Journal Detail:
Title:  Journal of evaluation in clinical practice     Volume:  14     ISSN:  1365-2753     ISO Abbreviation:  J Eval Clin Pract     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-05-08     Completed Date:  2008-06-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9609066     Medline TA:  J Eval Clin Pract     Country:  England    
Other Details:
Languages:  eng     Pagination:  378-84     Citation Subset:  IM    
Epidemiology Unit, Faculty of Medicine, Prince of Songkhla University, Hat-Yai, Songkhla, Thailand.
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MeSH Terms
Antitubercular Agents / administration & dosage*
Cross-Sectional Studies
Diagnostic Errors
Guideline Adherence*
Hospitals, Public
Interviews as Topic
Logistic Models
Medical Audit
Personnel, Hospital
Retrospective Studies
Tuberculosis / diagnosis*,  drug therapy*
Reg. No./Substance:
0/Antitubercular Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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