Determinants of patient and health care services delays for tuberculosis diagnosis in Italy: a cross-sectional observational study

Abstract

BackgroundPrompt diagnosis of active tuberculosis (TB) has paramount importance to reduce TB morbidity and mortality and to prevent the spread of Mycobacterium tuberculosis. Few studies so far have assessed the diagnostic delay of TB and its risk factors in low-incidence countries.MethodsWe present a cross-sectional multicentre observational study enrolling all consecutive patients diagnosed with TB in seven referral centres in Italy. Information on demographic and clinical characteristics, health-seeking trajectories and patients’ knowledge and awareness of TB were collected. Diagnostic delay was assessed as patient-related (time between symptoms onset and presentation to care) and healthcare-related (time between presentation to care and TB diagnosis). Factors associated with patient-related and healthcare-related delays in the highest tertile were explored using uni- and multivariate logistic regression analyses.ResultsWe enrolled 137 patients, between June 2011 and May 2012. The median diagnostic delay was 66 days (Interquartile Range [IQR] 31–146). Patient-related and healthcare-related delay were 14.5 days (IQR 0–54) and 31 days (IQR: 7.25–85), respectively. Using multivariable analysis, patients living in Italy for < 5 years were more likely to have longer patient-related delay (> 3 weeks) than those living in Italy for > 5 years (Odds Ratio [OR] 3.47; 95% Confidence Interval [CI] 1.09–11.01). The most common self-reported reasons to delay presentation to care were the mild nature of symptoms (82%) and a good self-perceived health (76%). About a quarter (26%) of patients had wrong beliefs and little knowledge of TB, although this was not associated with longer diagnostic delay. Regarding healthcare-related delay, multivariate analysis showed that extra-pulmonary TB (OR 4.3; 95% CI 1.4–13.8) and first contact with general practitioner (OR 5.1; 95% CI 1.8–14.5) were both independently associated with higher risk of healthcare-related delay > 10 weeks.ConclusionsIn this study, TB was diagnosed with a remarkable delay, mainly attributable to the healthcare services. Delay was higher in patients with extra-pulmonary disease and in those first assessed by general practitioners. We suggest the need to improve knowledge and raise awareness about TB not only in the general population but also among medical providers. Furthermore, specific programs to improve access to care should be designed for recent immigrants, at significantly high risk of patient-related delay.Trial registrationThe study protocol was registered under the US National Institute of Health ClinicalTrials.gov register, reference number: NCT01390987. Study start date: June 2011.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3609-4) contains supplementary material, which is available to authorized users.

Determination of related factors about diagnostic and treatment delays in patients with smear-positive pulmonary tuberculosis in Turkey

“…The most frequent reason for the patient delay is that patients with TB tend to neglect the symptoms [22]. In a previous study performed in Italy, one of the most frequent reasons for delays in treatment was the light nature of the symptoms (82%) and feeling healthy (76%) [23]. In our study, we found that patients whose first symptoms were cough, weight loss, night sweats, exhaustion, and hoarseness tended to neglect these symptoms and consult a physician much later.…”

“…We determined that the diagnosis delay was significantly shorter in patients who were consulted by chest physicians, dispensary physicians, and ER ward physicians than by other physicians. In a study performed in Italy, it was observed that the delay was longer when patients were first evaluated by family physicians [23]. According to a study performed in Ethiopia, seeing a family physician first was one of the independent indicators of the health system [29].…”

Influência de gênero na adesão ao tratamento da tuberculose

“…Não se pode afirmar como tal questão influencia na adesão de homens e mulheres ao tratamento da tuberculose, entretanto, reafirma-se realidade condicionada socialmente ao gênero (Kergoat, 1996;Toledo, 2008;Biroli, 2014;Herrero et al, 2015). (Bertolozzi, 2005;Andrade et al, 2017;PERI et al, 2018).…”

“…A identificação da sintomatologia, aliada à busca pelo serviço adequado para o diagnóstico da TB pelos pacientes pode auxiliar no diagnóstico precoce e contribuir para dirimir o sofrimento dos pacientes, com consequências importantes na adesão ao tratamento (Wang et al, 2008;Dantas et al, 2018;Yang et al, 2018). De fato, o atraso no diagnóstico é uma das causas da disseminação do bacilo de Koch e consequentemente do aumento da incidência (Jurcev-Savicevic et al, 2013;Cai et al, 2015;Cohen et al, 2018;Dantas et al, 2018;Peri et al, 2018).…”

“…Alguns estudos demonstram que os homens buscam, prioritariamente, unidades hospitalares como primeira opção (Queiroz, Nogueira, 2010;Dantas et al, 2018;Peri et al, 2018), o que pode decorrer das características do serviço e da disponibilidade de acesso, em relação aos dias da semana e horários. (Long et al, 2001;Jurcev-Savicevic et al, 2013;Yang et al, 2018) Diferentemente do encontrado no presente estudo, a maioria das pesquisas ainda trazem a baciloscopia como o exame mais solicitado para a confirmação da TB (Miller et al, 2013;Chen et al, 2019).…”