How do private general practitioners manage tuberculosis cases? A survey in eight cities in Indonesia

Yodi Mahendradhata, Trisasi Lestari, Ari Probandari, Lucia Evi Indriarini, Erlina Burhan, Dyah Mustikawati, Adi Utarini, Yodi Mahendradhata, Trisasi Lestari, Ari Probandari, Lucia Evi Indriarini, Erlina Burhan, Dyah Mustikawati, Adi Utarini

Abstract

Background: Private practitioners (PPs) in high-burden countries often provide substandard tuberculosis (TB) treatment, leading to increased risk of drug resistance and continued transmission. TB case management among PPs in Indonesia has not been investigated in recent years, despite longstanding recognition of inadequate care and substantial investment in several initiatives. This study aimed to assess case management practices of private general practitioners (GPs) in eight major cities across Indonesia.

Methods: A cross-sectional survey of private GPs was carried out simultaneously in eight cities by trained researchers between August and December 2011. We aimed for a sample size of 627 in total, and took a simple random sample of GPs from the validated local registers of GPs. Informed consent was obtained from participants prior to interview. Diagnostic and treatment practices were evaluated based on compliance with national guidelines. Descriptive statistics are presented.

Results: Of 608 eligible GPs invited to participate during the study period, 547 (89.9%) consented and completed the interview. A low proportion of GPs (24.6-74.3%) had heard of the International Standards for TB care (ISTC) and only 41.2-68.9% of these GPs had participated in ISTC training. As few as 47.3% (90% CI: 37.6-57.0%) of GPs reported having seen presumptive TB. The median number of cases of presumptive TB seen per month was low (0-5). The proportion of GPs who utilized smear microscopy for diagnosing presumptive adult TB ranged from 62.3 to 84.6%. In all cities, a substantial proportion of GPs (12.0-45.5%) prescribed second-line anti-TB drugs for treating new adult TB cases. In nearly all cities, less than half of GPs appointed a treatment observer (13.8-52.0%).

Conclusions: The pattern of TB case management practices among private GPs in Indonesia is still not in line with the guidelines, despite longstanding awareness of the issue and considerable trialing of various interventions.

References

    1. WHO . Global tuberculosis report 2013. Geneva: WHO; 2013.
    1. Uplekar M, Pathania V, Raviglione M. Private practitioners and public health: weak links in tuberculosis control. Lancet. 2001;358:912–916. doi: 10.1016/S0140-6736(01)06076-7.
    1. WHO. Ninth meeting of the subgroup on public–private mix for TB care and control and global workshop on engaging large hospitals. Meeting report. Bangkok, Thailand 28–30 August 2013. Geneva: WHO; 2013.
    1. WHO . The stop TB strategy: building on and enhancing DOTS to meet the TB-related millennium development goals. Geneva: WHO; 2013.
    1. WHO. Public–private mix for TB care and control. Report of the 7th meeting of the subgroup on public–private mix for TB care and control Lille, France 23–24 October 2011. Geneva: WHO; 2012.
    1. WHO. Global strategy and targets for tuberculosis prevention, care and control after 2015. EB 134/12. Provisional Agenda Item 6.1. Geneva: WHO; 2013.
    1. Ministry of Health . Report of tuberculosis prevalence survey of Indonesia 2004. Jakarta: Ministry of Health Republic of Indonesia; 2005.
    1. Khan AJ, Khowaja S, Khan FS, Qazi F, Lotia I, Habib A, Mohammed S, Khan U, Amanullah F, Hussain H, Becerra MC, Creswell J, Keshavjee S. Engaging the private sector to increase tuberculosis case detection: an impact evaluation study. Lancet Infect Dis. 2012;8:608–616. doi: 10.1016/S1473-3099(12)70116-0.
    1. Naqvi SA, Naseer M, Kazi A, Pethani A, Naeem I, Zainab S, Fatmi Z. Implementing a public-private mix model for tuberculosis treatment in urban Pakistan: lessons and experiences. Int J Tuberc Lung Dis. 2012;6:817–821.
    1. Mahendradhata Y, Utarini A, Lazuardi U, Boelaert M, Van der Stuyft P. Private practitioners and tuberculosis case detection in Jogjakarta, Indonesia: actual role and potential. Trop Med Int Health. 2007;10:1218–1224. doi: 10.1111/j.1365-3156.2007.01946.x.
    1. Naseer M, Khawaja A, Pethani AS, Aleem S. How well can physicians manage tuberculosis? A public–private sector comparison from Karachi, Pakistan. BMC Health Serv Res. 2013;13:439. doi: 10.1186/1472-6963-13-439.
    1. Achanta S, Jaju J, Kumar AM, Nagaraja SB, Shamrao SR, Bandi SK, Kumar A, Satyanarayana S, Harries AD, Nair SA, Dewan PK. Tuberculosis management practices by private practitioners in Andhra Pradesh, India. PLoS One. 2013;8:e71119. doi: 10.1371/journal.pone.0071119.
    1. Baloch NA, Pai M. Tuberculosis control: business models for the private sector. Lancet Infect Dis. 2012;8:579–580. doi: 10.1016/S1473-3099(12)70122-6.
    1. Johns B, Probandari A, Ahmad RA, Mahendradhata Y. An analysis of the costs and treatment success of collaborative arrangements among public and private providers for tuberculosis control in Indonesia. Health Policy. 2009;93:214–224. doi: 10.1016/j.healthpol.2009.08.004.
    1. Mahendradhata Y, Probandari A, Ahmad RA, Utarini A, Trisnantoro L, Lindholm L, Van der Werf MJ, Kimerling ME, Boelaert M, Johns B, Van der Stuyft P. The incremental cost-effectiveness of engaging private practitioners to refer tuberculosis suspects to DOTS services in Jogjakarta, Indonesia. Am J Trop Med Hyg. 2010;6:1131–1139. doi: 10.4269/ajtmh.2010.09-0447.
    1. Putra IWGAE, Utami NW, Suarjana IK, Duana IM, Astiti CI, Putra I, Probandari A, Tiemersma EW, Wahyuni CU. Factors associated to referral of tuberculosis suspects by private practitioners to community health centres in Bali Province, Indonesia. BMC Health Serv Res. 2013;13:445. doi: 10.1186/1472-6963-13-445.
    1. Ministry of Health . National guideline for tuberculosis control. Jakarta: Ministry of Health, Republic of Indonesia; 2011.
    1. Al-Maniri AA, Al-Rawas OA, Al-Ajmi F, De Costa A, Eriksson B, Diwan VK. Tuberculosis suspicion and knowledge among private and public general practitioners: questionnaire based study in Oman. BMC Public Health. 2008;8:177. doi: 10.1186/1471-2458-8-177.
    1. Vandan N, Ali M, Prasad R, Kuroiwa C. Assessment of doctors’ knowledge regarding tuberculosis management in Lucknow, India: a public-private sector comparison. Public Health. 2009;7:484–489. doi: 10.1016/j.puhe.2009.05.004.
    1. Yimer SA, Holm-Hansen C, Bjune G. Assessment of knowledge and practice of private practitioners regarding tuberculosis control in Ethiopia. J Infect Dev Ctries. 2012;1:13–19.
    1. Bell CA, Duncan G, Saini B. Knowledge, attitudes and practices of private sector providers of tuberculosis care: a scoping review. Int J Tuberc Lung Dis. 2011;8:1005–1017. doi: 10.5588/ijtld.10.0294.
    1. JEMM. Report of the joint external monitoring mission. Indonesia, 16–27 April 2007. Jakarta: JEMM; 2007.
    1. JEMM. Report of the joint external monitoring mission. February 2013. Jakarta: JEMM; 2013.
    1. Dewan PK, Lai SS, Lonnroth K, Wares F, Uplekar M, Sahu S, Granich R, Chauhan LS. Improving tuberculosis control through public private collaboration in India: literature review. BMJ. 2006;7541:574–578. doi: 10.1136/bmj.38738.473252.7C.
    1. Lal SS, Sahu S, Wares F, Lönnroth K, Chauhan LS, Uplekar M. Intensified scale-up of public-private mix: a systems approach to tuberculosis care and control in India. Int J Tuberc Lung Dis. 2011;1:97–104.
    1. Pethani A, Zafar M, Khan AA. Rabbani Sana U, Ahmed S, Fatmi Z. Engaging general practitioners in public–private mix tuberculosis DOTS program in an urban area in Pakistan: need for context-specific approach. Asia Pac J Public Health. 2015;27(2):NP984–NP992. doi: 10.1177/1010539513483828.
    1. Portero JL, Rubio M. Private practitioners and tuberculosis control in the Philippines: strangers when they meet? Trop Med Int Health. 2003;4:329–335. doi: 10.1046/j.1365-3156.2003.01032.x.
    1. Chakaya JM, Meme H, Kwamanga D, Githui WA, Onyango-Ouma WO, Gicheha C, Karimi F, Mansoer J, Kutwa A. Planning for PPM-DOTS implementation in urban slums in Kenya: knowledge, attitude and practices of private health care providers in Kibera slum, Nairobi. Int J Tuberc Lung Dis. 2005;4:403–408.
    1. Grenier J, Pinto L, Nair D, Steingart K, Dowdy D, Ramsay A, Pai M. Widespread use of serological tests for tuberculosis: data from 22 high-burden countries. Eur Respir J. 2012;2:502–505. doi: 10.1183/09031936.00070611.
    1. Singh S, Singh J, Kumar S, Gopinath K, Balooni V, Singh N, Mani K. Poor performance of serological tests in the diagnosis of pulmonary tuberculosis: evidence from a contact tracing field study. PLoS ONE. 2012;7:e40213. doi: 10.1371/journal.pone.0040213.
    1. Udwadia ZF, Pinto LM, Uplekar MW. Tuberculosis management by private practitioners in Mumbai, India: has anything changed in two decades? PLoS One. 2010;8:e12023. doi: 10.1371/journal.pone.0012023.
    1. Wells WA, Ge CF, Patel N, Oh T, Gardiner E, Kimerling ME. Size and usage pattern of private TB drug markets in the high burden countries. PLoS One. 2011;4:e18964. doi: 10.1371/journal.pone.0018964.
    1. Chiang CY, Centis R, Migliori GB. Drug-resistant tuberculosis: past, present, future. Respirology. 2010;3:413–432. doi: 10.1111/j.1440-1843.2010.01738.x.
    1. Rokx C, Giles J, Satriawan E, Marzoeki P, Harimurti P, Yavuz E. New insights into the provision of health services in Indonesia. A health workforce study. Washington DC: World Bank; 2010.
    1. Mok EA, Gostin LO, Das Gupta M. Implementing public health regulations in developing countries: lessons from the OECD countries. J Law Med Ethics. 2010;3:508–519. doi: 10.1111/j.1748-720X.2010.00509.x.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться