Patient-centered approach to the management of drug-resistant tuberculosis in France: How far off the mark are we?

Abstract

Drug-resistant tuberculosis (DR-TB) is a major public health concern worldwide. The prolonged isolation required is a source of challenges for both healthcare workers and patients, especially in high-income countries where DR-TB patients are frequently migrants with vulnerabilities. However, data on the needs of these vulnerable patients are scarce. Our objective was to identify and quantify conflict or inappropriate care situations experienced by both DR-TB patients and healthcare workers. This 10-year retrospective observational study (01/2008 to 10/2018) was conducted in a referral center for resistant tuberculosis management in Paris, France. Sixty-five DR-TB patients were hospitalized during the study period. Their demographic, clinical and social characteristics and any conflict or inappropriate care situations they experienced with healthcare workers while hospitalized were analyzed. Conflict or inappropriate care situations with healthcare workers were reported for 24 patients during their stay (36.9%). Eleven patients (16.9%) had difficulty adhering to respiratory isolation rules, 15 (23.1%) were discharged against medical advice, 9 (13.8%) were excluded from hospital for disciplinary reasons, verbal or physical violence was reported for 7 patients (10.8%), and 4 arrests (6.2%) were made by the police. Conflict situations were reported more often when there was a language barrier (70.8%, p<0.0001). More than one-third of patients with DR-TB in this referral center experienced at least one inappropriate care situation with healthcare workers. This study illustrates the urgent need to promote a patient-centered approach and to respond to the challenges of its practical implementation.

Revised Definitions of Tuberculosis Resistance and Treatment Outcomes, France, 2006–2019

“…A likely explanation is the high proportion of lost-to-follow-up (18.1%) and nonevaluated (11.4%) outcomes, which account for 92% of all unfavorable outcomes in our real-world cohort. This reasoning is consistent with previous findings showing that even high-income settings have room to improve with respect to supports provided to MDR TB patients ( 33 ), especially when a high proportion is not locally born and may not be permanent residents.…”