How do private general practitioners manage tuberculosis cases? A survey in eight cities in Indonesia
Abstract
Background
Private practitioners
(PPs) in high-burden countries often provide substandard
tuberculosis (TB) treatment, leading to increased risk of drug
resistance and continued transmission. TB case management among
PPs in Indonesia has not been investigated in recent years,
despite longstanding recognition of inadequate care and
substantial investment in several initiatives. This study aimed
to assess case management practices of private general
practitioners (GPs) in eight major cities across Indonesia.
Methods
A cross-sectional survey of
private GPs was carried out simultaneously in eight cities by
trained researchers between August and December 2011. We aimed
for a sample size of 627 in total, and took a simple random
sample of GPs from the validated local registers of GPs.
Informed consent was obtained from participants prior to
interview. Diagnostic and treatment practices were evaluated
based on compliance with national guidelines. Descriptive
statistics are presented.
Results
Of 608 eligible GPs invited
to participate during the study period, 547 (89.9 %) consented
and completed the interview. A low proportion of GPs
(24.6–74.3 %) had heard of the International Standards for
TB care (ISTC) and only 41.2–68.9 % of these GPs had
participated in ISTC training. As few as 47.3 % (90 % CI:
37.6–57.0 %) of GPs reported having seen presumptive TB.
The median number of cases of presumptive TB seen per month was
low (0–5). The proportion of GPs who utilized smear
microscopy for diagnosing presumptive adult TB ranged from 62.3
to 84.6 %. In all cities, a substantial proportion of GPs
(12.0–45.5 %) prescribed second-line anti-TB drugs for
treating new adult TB cases. In nearly all cities, less than
half of GPs appointed a treatment observer (13.8–52.0 %).
Conclusions
The pattern of TB case
management practices among private GPs in Indonesia is still not
in line with the guidelines, despite longstanding awareness of
the issue and considerable trialing of various interventions.
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Source:
BMC Research Notes
