title: Referral of tuberculosis symptomatic clients from private pharmacies to public sector clinics for diagnosis and treatment in Cambodia.
abstract: OBJECTIVE
  Cambodia is one of the 22 countries with a high burden of tuberculosis (TB). People often first seek treatment for cough and other TB symptoms through private pharmacies. The National Tuberculosis Programme trained willing private sector pharmacies to refer TB symptomatic clients to their closest public sector clinic for diagnosis and treatment. The study objective was to investigate factors associated with referral of TB symptomatic clients from pharmacies to public sector clinics in Phnom Penh, Cambodia.
  
  
  METHODS
  Face-to-face structured interviews were conducted with staff from a stratified random sample of 180 private pharmacies in Phnom Penh in 2012. Trained interviewers were Khmer speakers. Logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with self-reported referral during the previous 3 months.
  
  
  RESULTS
  Fifty (29.6%) pharmacies reported that they had referred 125 clients (range 1-10) to public sector clinics during the previous 3 months. In total, 164 (96.5%) pharmacies reported that they always referred all TB symptomatic clients to DOTS (directly observed treatment, short course) clinics. More than 6-year participation in the programme (OR 5.23, 95% CI 1.93-14.18) and willingness to always continue referring (OR 12.24, 95% CI 11.61-93.10) were associated with referral of one or more clients in the previous 3 months. Referral to the client's closest clinic was negatively associated with referral (OR 0.45, 95% CI 0.23-0.99).
  
  
  CONCLUSIONS
  Pharmacies' ongoing commitment to the Referral Programme was strongly associated with referral. Increased advocacy among the high number of non-referring pharmacies may improve programme performance. Factors negatively associated with referral may need investigation.
authors: Faculty of Pharmacy, University of Sydney, Sydney, Australia.
authors: Carolyn A
authors: CA
authors: Bell
authors: Jenni
authors: J
authors: Ilomäki
authors: Koeut
authors: K
authors: Pichenda
authors: Gregory J
authors: GJ
authors: Duncan
authors: Bandana
authors: B
authors: Saini
mesh_terms: D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002160:Cambodia; D003157:Community Pharmacy Services; D023801:Directly Observed Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017149:Private Sector; D017150:Public Sector; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy*
chemical_list: D000995:Antitubercular Agents
keywords: Cambodia; PPM; health services; pharmacies; referral and consultation; tuberculosis