B Sanz1, T Blasco. 1. National Centre of Tropical Medicine, Instituto de Salud Carlos III, Madrid, Spain. bsanz@isciii.es
Abstract
OBJECTIVE: To identify variables associated with total diagnostic delay (TDD), patient delay (PD) and health service delay (HSD), among the tuberculous immigrant population in the Autonomous Community of Madrid (ACT). METHODOLOGY: Tuberculosis cases diagnosed in 15 hospitals in the ACT in 2003 were interviewed face-to-face and medical records were reviewed. A descriptive study was conducted, followed by univariate and multivariate analysis using non-conditional logistic regressions. 50th (p50) and 75th (p75) percentiles of the different diagnostic delay components were analysed as dependent variables. RESULTS: For the 296 cases included, the mean TDD was 40.5 days (IQR 16.0-90.0), the PD was 15 days (IQR 6.5-30.0), and the HSD was 5 days (IQR 0.0-30.0). TDD-p75 is associated with seeking primary health care (OR 2.87, 95%CI 1.47-5.58). PD-p75 is associated with identification of fever (OR 0.49, 95%CI 0.25-0.92) and non-identification of cough (OR 1.87, 95%CI 1.05-3.36) as symptoms resulting in health care being sought. The HSD-p75 is associated with primary health care being sought (OR 3.81, 95%CI 1.87-7.78), health cover (OR 15.07, 95%CI 1.96-115.68) and negative smear results at the time of diagnosis (OR 1.98, 95%CI 1.01-3.91). CONCLUSIONS: The HSD needs to be reduced, mainly when health care is sought through the primary care services and among patients with negative smear results.
OBJECTIVE: To identify variables associated with total diagnostic delay (TDD), patient delay (PD) and health service delay (HSD), among the tuberculous immigrant population in the Autonomous Community of Madrid (ACT). METHODOLOGY:Tuberculosis cases diagnosed in 15 hospitals in the ACT in 2003 were interviewed face-to-face and medical records were reviewed. A descriptive study was conducted, followed by univariate and multivariate analysis using non-conditional logistic regressions. 50th (p50) and 75th (p75) percentiles of the different diagnostic delay components were analysed as dependent variables. RESULTS: For the 296 cases included, the mean TDD was 40.5 days (IQR 16.0-90.0), the PD was 15 days (IQR 6.5-30.0), and the HSD was 5 days (IQR 0.0-30.0). TDD-p75 is associated with seeking primary health care (OR 2.87, 95%CI 1.47-5.58). PD-p75 is associated with identification of fever (OR 0.49, 95%CI 0.25-0.92) and non-identification of cough (OR 1.87, 95%CI 1.05-3.36) as symptoms resulting in health care being sought. The HSD-p75 is associated with primary health care being sought (OR 3.81, 95%CI 1.87-7.78), health cover (OR 15.07, 95%CI 1.96-115.68) and negative smear results at the time of diagnosis (OR 1.98, 95%CI 1.01-3.91). CONCLUSIONS: The HSD needs to be reduced, mainly when health care is sought through the primary care services and among patients with negative smear results.