Reform of tuberculosis control and DOTS within Russian public health systems: an ecological study.
OBJECTIVE
To investigate the association between clinical need and hospital bed supply and utilization in Russia; and, to investigate these associations in areas where traditional Russian tuberculosis health care systems exist and where the directly observed therapy-short course (DOTS) strategy has been implemented.


METHODS
Ecological study using 2002 routine data.


METHODS
Hospital bed utilization and hospital admissions for patients with tuberculosis in regions that adhere to the traditional Russian method of managing tuberculosis and those where the DOTS strategy has been implemented.


RESULTS
The ratio of beds per newly notified case was 0.86. The mean duration of hospital stay per admission was 86 days for non-DOTS regions and 90 days for regions where the DOTS strategy had been implemented. The number of admissions in each region correlated closely with the number of newly registered cases and hospital beds were, on average, occupied for 325 days. In the regions where the DOTS strategy had been implemented bed occupancy was 324 days.


CONCLUSIONS
Under the Russian tuberculosis control system, hospital utilization is predominantly determined by supply-side factors, namely the number of tuberculosis dedicated hospital beds, and this system extends across all regions. Implementation of the DOTS strategy in Russia has not led to fundamental structural changes in tuberculosis control systems.
Marx
Florian M
FM
Department of Public Health and Policy, London School of Hygiene and Tropical Medicine Keppel Street, London, UK.
Atun
Rifat A
RA
Jakubowiak
Wieslaw
W
McKee
Martin
M
Coker
Richard J
RJ
D001509:Bed Occupancy / Q000706:statistics & numerical data; D003140:Communicable Disease Control / Q000379:methods* / Q000458:organization & administration / Q000706:statistics & numerical data; D003695:Delivery of Health Care / Q000379:methods* / Q000458:organization & administration / Q000706:statistics & numerical data; D023801:Directly Observed Therapy / Q000379:methods / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D011634:Public Health / Q000379:methods*; D012426:Russia; D013997:Time Factors; D014376:Tuberculosis / Q000188:drug therapy / Q000517:prevention & control*