Evaluating the impact of decentralising tuberculosis microscopy services to rural township hospitals in gansu province, china

Tropical Med Int Health

Yin

Zou

et al. 2013

Self Cite

Abstractobjective To report care pathways of tuberculosis (TB) patients under the integrated model, where TB clinical service is provided by a general hospital instead of the TB dispensary, with the aim of providing policy recommendations for TB care reforms in China.methods Six counties implementing the integrated model were randomly selected, and 50 TB patients in each county participated in a questionnaire survey.results Of the 301 participants, 82 visited only the TB designated hospital. A patient visited a median of two health providers in total. The median external provider delay and internal provider delay were 1 and 0 day, respectively. The median out-of-pocket medical costs were US$379 in total; US$293 in the TB units and US$0 in other health units in the TB designated hospital. Logistic regression analyses suggested that patients who visited the primary care facilities first tended to have longer external delays (OR = 5.71) than patients who visited the other hospitals (OR = 10.16).conclusion The integrated model is promising as it reported relatively fewer patient pathways and shorter delays than the dispensary model. However, the integrated model did not reduce patient outof-pocket costs.

Section: Discussionmentioning

confidence: 97%

Patient care pathways under the model of integrating tuberculosis service with general hospitals in China

Tropical Med Int Health

Yin

Zou

et al. 2013

Self Cite

“…patients highly suggestive of TB after X‐ray and physical examinations (Fan 2008; Li et al. 2008; Wei et al. 2011).…”

Section: Discussionmentioning

confidence: 99%

“…The possible reason was that the majority of TB suspects presented in TB dispensaries were referred by doctors in general hospitals, i.e. patients highly suggestive of TB after X-ray and physical examinations (Fan 2008;Li et al 2008;Wei et al 2011).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of active tuberculosis case finding through symptom screening and sputum microscopy of close contacts in Shandong, China

Zhang

Tropical Med Int Health

Zou

et al. 2011

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Summaryobjectives To evaluate the effect of active case finding through symptom screening and sputum microscopy of close contacts in a Fidelis (Fund for Innovative DOTS Expansion through Local Initiatives to Stop TB) project.methods Secondary data from all 35 counties were collected during implementation and used. They comprised new cases identified, number of close contacts screened and their relationships. Fifty-four in-depth interviews were conducted with staff from key stakeholders.results A total of 13 310 symptomatic contacts of 5255 index cases were screened, and 90 new smear-positive cases were detected with a yield rate of 0.7%. The yield rate of close contacts was positively associated with smear grades of the index cases (P < 0.01). Close contacts of cases, such as classmates and workmates, who lived in a closed contained setting, had a higher yield rate than family members (P < 0.001). Gaps in project implementation such as training, incentives and sputum collection were identified through in-depth interviews.conclusions The yield rate of close-contact screening of 0.7% was similar to other findings in China.There was a higher yield from screening of close contacts in congregated settings like schools and workshops. Future active case finding projects should provide clear operational guidelines and adequate training.

“…To date, a few studies in China have reported the experience of integrating TB services in the township hospitals (functioning as health centers) of Guangxi [ 20 , 21 ], Shandong [ 22 , 23 ] and Gansu provinces [ 24 ]. However, there is a lack of published evidence on the integration of TB care in the general hospitals.…”

Section: Introductionmentioning

confidence: 99%

Factors influencing integration of TB services in general hospitals in two regions of China: a qualitative study

Zou¹,

Walley

et al. 2012

BMC Health Serv Res

Self Cite

BackgroundIn the majority of China, the Centre for Disease Control (CDC) at the county level provides both clinical and public health care for TB cases, with hospitals and other health facilities referring suspected TB cases to the CDC. In recent years, an integrated model has emerged, where the CDC remains the basic management unit for TB control, while a general hospital is designated to provide clinical care for TB patients. This study aims to explore the factors that influence the integration of TB services in general hospitals and generate knowledge to aid the scale-up of integration of TB services in China.MethodsThis study adopted a qualitative approach using interviews from sites in East and West China. Analysis was conducted using a thematic framework approach.ResultsThe more prosperous site in East China was more coordinated and thus had a better method of resource allocation and more patient-orientated service, compared with the poorer site in the West. The development of public health organizations appeared to influence how effectively integration occurred. An understanding from staff that hospitals had better capacity to treat TB patients than CDCs was a strong rationale for integration. However, the economic and political interests might act as a barrier to effective integration. Both sites shared the same challenges of attracting and retaining a skilled workforce for the TB services. The role of the health bureau was more directive in the Western site, while a more participatory and collaborative approach was adopted in the Eastern site.ConclusionThe process of integration identifies similarities and differences between sites in more affluent East China and poorer West China. Integration of TB services in the hospitals needs to address the challenges of stakeholder motivations and resource allocation. Effective inter-organizational collaboration could help to improve the efficiency and quality of TB service. Key words: TB control, service delivery, integration, hospitals, China.