title: Patient and health service delays in initiating treatment for patients with pulmonary tuberculosis: retrospective cohort study.
abstract: METHODS
  Catchment population of the North Middlesex University Hospital (NMUH), London, UK.
  
  
  OBJECTIVE
  To measure patient and health care delays in treatment of pulmonary tuberculosis.
  
  
  METHODS
  Retrospective cohort study of patients notified with pulmonary tuberculosis between 1 April 2001 and 1 March 2002.
  
  
  RESULTS
  The median case finding delays were between 78 and 99 days. Median patient-related delay was between 34.5 and 54 days. Median health care-related delay was 29.5 days. Shorter case finding delays were found in patients born in a high prevalence country, patients presenting first to Accident and Emergency department (A&E), younger patients, and those with sputum smear-positive disease. In those presenting first to A&E, those born in a high prevalence country, and those with sputum-positive disease, this effect was predominantly due to shorter health care delays. Limitations of TB service capacity and organisational factors appeared responsible for up to half of the difference in delay between those presenting to A&E or general practitioners (GPs).
  
  
  CONCLUSIONS
  Patient and health service delays contribute substantially to delays in patients accessing treatment. Considerable reduction in case finding delays may be achieved through changes in the capacity of tuberculosis services, and coordination of associated health services.
authors.affiliation: Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Paynter
authors.forename: A
authors.initials: A
authors.lastname: Hayward
authors.forename: P
authors.initials: P
authors.lastname: Wilkinson
authors.forename: S
authors.initials: S
authors.lastname: Lozewicz
authors.forename: R
authors.initials: R
authors.lastname: Coker
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006785:Hospitals, University; D006801:Humans; D008131:London; D008297:Male; D010342:Patient Acceptance of Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000628:therapy*