Strengthening tuberculosis patient referral mechanisms among health facilities in Punjab, Pakistan

Abstract

The present study indicates that utilisation of a referral register (e-TRTR), appointment of a responsible person for patient referral at the hospital, close monitoring of the referral by telephone and communication with responsible TB coordinators bring about a considerable improvement in the TB patient referral mechanism.

Interventions to improve adherence to treatment for paediatric tuberculosis in low- and middle-income countries: a systematic review and meta-analysis

“…Three of the studies were published in Portuguese 11 , 13 , 14 and the remainder in English. Five studies were based in the upper-middle-income countries of Brazil 11 , 13 , 14 and Thailand, 15 , 16 three in the lower-middle-income countries of India, 12 Lesotho 10 and Pakistan, 17 and seven in the low-income countries of Bangladesh, 23 Ethiopia, 18 , 19 Kenya, 22 Myanmar, 24 South Sudan 21 and the United Republic of Tanzania. 20 Four settings were urban outpatient, 11 , 13 , 16 , 17 three rural outpatient, 12 , 18 , 19 two suburban outpatient, 23 , 24 one rural camp.…”

“…Care delivery interventions included health provider training, 10 , 16 – 19 , 21 , 22 , 24 convenient appointment scheduling, 10 , 12 , 19 , 23 migration-sensitive therapy duration 21 and easier dosing schedules. 10 , 12 , 18 , 24 Health system interventions included the directly observed treatment, short-course strategy, 10 – 12 , 15 , 16 , 18 – 22 referral support, 17 , 19 patient tracers 10 , 12 , 16 – 19 , 21 , 22 , 24 – including tracing within 24 hours 12 , 21 – and home visiting. 16 , 22 …”

“…Adherence-related measures included those extracted from self-reports, 16 , 24 pharmacy refill data, 23 medication records maintained by treatment supporters, 12 , 19 clinic attendance records, 23 confirmation of referrals 17 and medical records. 10 , 11 , 13 – 15 , 18 , 20 – 22 , 24 …”

“…completion or cure – positive outcomes were defined in the study reports as successful referral – i.e. confirmed arrival at the referral facility, 17 continuous attendance at scheduled visits, 22 , 23 more than 90% medication adherence 23 or self-reported beneficial health behaviours. 16…”

Using mobile phones to ensure that referred tuberculosis patients reach their treatment facilities: a call that makes a difference

“…Importantly, since there is currently no nationally recommended mechanism to track patients referred out, the utility of this intervention will be of particular interest. Although there have been several mHealth studies that have assessed adherence after TB treatment has been initiated, none have assessed its use for retaining referred patients within the health system [ 5 – 8 ].…”