Patient, Healthcare System and Total Delay in Tuberculosis Diagnosis and Treatment among Serbian Population

Abstract

SUMMARY – Currently, topical are studies that examine different reasons for delay of tuberculosis (TB) diagnosis and its impact on disease prognosis. The aim was to examine three time periods associated with treatment delay: patient related, health system related and total delay. This retrospective-prospective study included 100 consecutive patients hospitalized at Department of Pulmonology, Clinical Center of Serbia, in the period from March to December 2015. Study results showed median patient delay to be 92.5 days. Total delay was affected by patient related delay. Median healthcare delay was 18.5 days. Patients that reported excessive alcohol consumption were more likely to have prolonged time to seek medical help. Years of alcohol consumption yielded moderate positive correlation with patient related delay (r=0.362, p<0.001). Correlation between the number of cigarettes and patient delay was moderate, positive and statistically significant (r=0.314, p=0.001). Delay in seeking medical help was more likely in patients with negative family history of TB. There was no difference in the effect of the presence of symptoms on patient related delay (p>0.05). Clinical characteristics such as patient TB category and chest radiograph abnormalities were not associated with prolonged patient related delay (p>0.05). Study results point to the importance of health education and/or health intervention in the population group at a high risk of TB.

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

“…Thus, in current smokers, the diagnosis delay was shorter (median = 19 days) than in non-smokers (median = 26 days). In a study conducted in Serbia, a medium, positive, and statistically significant correlation was found between the number of cigarette smoked and the patient delay [27].…”

Delayed diagnosis of active pulmonary tuberculosis - potential risk factors for patient and healthcare delays in Portugal

“…Alcohol abuse and unemployment presented an association with longer delays, more specifically between beginning of symptoms and seeking help from the healthcare services. Previous studies [ 23 , 50 , 51 ] have established that patients with addictions are less likely to visit the healthcare services in a timely manner. This may result from the fact that patients who consume alcohol in excess may not seek, or easily have access to, healthcare providers when they start presenting symptoms and realize they are ill, resulting in delayed diagnosis and more advanced disease [ 52 ].…”

Patient delay of patients with pulmonary tuberculosis in Yantai, China, 2013 to 2022: Analysis of a case series

“…Delays in any part of the healthcare-seeking process for patients with tuberculosis can lead to the transmission of Mycobacterium tuberculosis, and are one of the major factors hindering the achievement of the 2030 tuberculosis elimination goal. [1,2] Patient delay (onset of symptoms to first visit) may increase the severity of the disease, prolong patient suffering, lead to complications, affect treatment outcomes and exacerbate the financial burden on patients, [3,4] and on the other hand, may increase the risk of tuberculosis infection in the population, leading to higher morbidity and mortality. [5] Minimizing the delays that may occur in patients with tuberculosis is a key part of the tuberculosis control chain.…”

“…In terms of region of residence, some studies [3,14] have shown that patients living in less economically developed areas (rural or peri-urban) are more likely to experience patient delay, which may be related to the lack of transportation and single mode of travel in rural areas, the relative scarcity of healthcare resources, and the poorer accessibility to healthcare.…”