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.
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.
Authors: J Lucian Davis; Adithya Cattamanchi; Luis E Cuevas; Philip C Hopewell; Karen R Steingart Journal: Lancet Infect Dis Date: 2012-10-23 Impact factor: 25.071
Authors: C R Miller; J L Davis; A Katamba; A Sserwanga; S Kakeeto; F Kizito; A Cattamanchi Journal: Int J Tuberc Lung Dis Date: 2013-04 Impact factor: 2.373
Authors: Luis Eduardo Cuevas; Mohammed Ahmed Yassin; Najla Al-Sonboli; Lovett Lawson; Isabel Arbide; Nasher Al-Aghbari; Jeevan Bahadur Sherchand; Amin Al-Absi; Emmanuel Nnamdi Emenyonu; Yared Merid; Mosis Ifenyi Okobi; Juliana Olubunmi Onuoha; Melkamsew Aschalew; Abraham Aseffa; Greg Harper; Rachel Mary Anderson de Cuevas; Kristin Kremer; Dick van Soolingen; Carl-Michael Nathanson; Jean Joly; Brian Faragher; Stephen Bertel Squire; Andrew Ramsay Journal: PLoS Med Date: 2011-07-12 Impact factor: 11.069
Authors: Wei-Teng Yang; Celine R Gounder; Tokunbo Akande; Jan-Walter De Neve; Katherine N McIntire; Aditya Chandrasekhar; Alan de Lima Pereira; Naveen Gummadi; Santanu Samanta; Amita Gupta Journal: Tuberc Res Treat Date: 2014-04-28