Factors related to health system delays in the diagnosis of pulmonary tuberculosis in Estonia.
OBJECTIVE
To estimate health system delays (HSD) in the diagnosis of pulmonary tuberculosis (PTB) and its risk factors after major social changes in Estonia, and to assess the ability of a completely reformed health care system to diagnose patients with PTB.


METHODS
All newly detected symptomatic culture-positive patients with PTB aged > or = 16 years from Southern Estonia during 2002-2003 (n = 185) were interviewed. HSD was defined as the interval from a patient's first contact with a medical provider to the date of TB diagnosis.


RESULTS
The factors significantly associated with HSD greater than the median (19 days) and the 75th percentile (40 days) were smear negativity, absence of cough among symptoms, absence of chest X-ray during the first visit and age > 60 years. A significantly shorter HSD was determined in non-Estonians and unemployed patients. HSD was not associated with the specialty of the doctor first contacted by the patient.


CONCLUSIONS
This study in Southern Estonia shows that the health care system is still managing the diagnosis of PTB without significant delays, even after substantial modifications in the health care system resulting from social reform in a post-socialist country, and that family physicians can manage PTB patients successfully.
Pehme
L
L
Department of Pulmonary Medicine, University of Tartu, Estonia. Lea.Pehme@kliinikum.ee
Rahu
K
K
Rahu
M
M
Altraja
A
A
D000328:Adult; D004957:Estonia / Q000453:epidemiology; D005260:Female; D018166:Health Care Reform; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011057:Politics; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology