Factors affecting delays in diagnosis and treatment of pulmonary tuberculosis in a tertiary care hospital in Istanbul, Turkey.
BACKGROUND
To investigate delays in the diagnosis and treatment of inpatients with smear-positive pulmonary tuberculosis and to identify factors affecting these delays.


METHODS
204 hospitalized patients with smear-positive pulmonary tuberculosis were identified. The clinical files of the patients were analyzed and questionnaires were created.


RESULTS
Mean application interval was 31.4 days, mean referral interval was 22.1 days, mean diagnosis interval was 3.3 days, and mean initiation of treatment interval was 1.4 days. Patient delay was present in 34.8 percent of the patients. The application interval was shorter for patients having an index case for tuberculosis (p=0.039) and for those with good economic status (p<0.005). 167 patients (81.9%) had institutional delay. The referral interval was longer for female patients than for male patients (p=0.015). The most common causes of institutional delays were a low index of suspicion for tuberculosis, health care system delays, and underutilized chest X-ray examinations. One hundred and three patients (50.5%) had delays in diagnosis and 51 patients (25.0%) had delays in treatment. The most frequent reason for diagnostic delay was health care system delays (35.9%).


CONCLUSIONS
There were several delays in the diagnosis of tuberculosis patients. For an effective tuberculosis control, efforts should be made to reduce these delays. Physicians and the public should be educated about tuberculosis. Health care system and laboratory delays should be improved.
Güneylioglu
Döndü
D
Department of Pulmonology, SSK Süreyyapaşa Center for Chest Diseases and Thoracic Surgery, Istanbul, Turkey.
Yilmaz
Adnan
A
Bilgin
Sevinç
S
Bayram
Ummühan
U
Akkaya
Esen
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care / Q000592:standards* / Q000706:statistics & numerical data; D003710:Demography; D005260:Female; D006769:Hospitals, General; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010346:Patient Care Management / Q000592:standards / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000628:therapy*; D014421:Turkey