Missed opportunity for standardized diagnosis and treatment among adult tuberculosis patients in hospitals involved in Public-Private Mix for Directly Observed Treatment Short-Course strategy in Indonesia: a cross-sectional study.
BACKGROUND
The engagement of hospitals in Public-Private Mix (PPM) for Directly Observed Treatment Short-Course (DOTS) strategy has increased rapidly internationally - including in Indonesia. In view of the rapid global scaling-up of hospital engagement, we aimed to estimate the proportion of outpatient adult Tuberculosis patients who received standardized diagnosis and treatment at outpatients units of hospitals involved in the PPM-DOTS strategy.


METHODS
A cross-sectional study using morbidity reports for outpatients, laboratory registers and Tuberculosis patient registers from 1 January 2005 to 31 December 2005. By quota sampling, 62 hospitals were selected. Post-stratification analysis was conducted to estimate the proportion of Tuberculosis cases receiving standardized management according to the DOTS strategy.


RESULTS
Nineteen to 53% of Tuberculosis cases and 4-18% of sputum smear positive Tuberculosis cases in hospitals that participated in the PPM-DOTS strategy were not treated with standardized diagnosis and treatment as in DOTS.


CONCLUSIONS
This study found that a substantial proportion of TB patients cared for at PPM-DOTS hospitals are not managed under the DOTS strategy. This represents a missed opportunity for standardized diagnoses and treatment. A combination of strong individual commitment of health professionals, organizational supports, leadership, and relevant policy in hospital and National Tuberculosis Programme may be required to strengthen DOTS implementation in hospitals.
Probandari
Ari
A
Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Indonesia. ariprobandari@yahoo.com
Lindholm
Lars
L
Stenlund
Hans
H
Utarini
Adi
A
Hurtig
Anna-Karin
AK
D000328:Adult; D003430:Cross-Sectional Studies; D023801:Directly Observed Therapy / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D016304:Hospitals, Private; D006779:Hospitals, Public; D006801:Humans; D007214:Indonesia; D008297:Male; D016134:Organizational Policy; D010342:Patient Acceptance of Health Care; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis / Q000628:therapy*
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