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      Using Patient Pathway Analysis to Design Patient-centered Referral Networks for Diagnosis and Treatment of Tuberculosis: The Case of the Philippines

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          Abstract

          Background

          Tuberculosis (TB) is the 8th leading cause of death in the Philippines. A recent prevalence survey found that there were nearly 70% more cases of tuberculosis than previously estimated. Given these new data, the National TB Program (NTP), operating through a decentralized health system, identified about 58% of the estimated new drug-sensitive (DS) TB patients in 2016. However, the NTP only identified and commenced treatment for around 17% of estimated new drug-resistant patients. In order to reach the remaining 42% of drug-sensitive patients and 83% of drug-resistant patients, it is necessary to develop a better understanding of where patients seek care.

          Methods

          National and regional patient pathway analyses (PPAs) were undertaken using existing national survey and NTP data. The PPA assessed the alignment between patient care seeking and the availability of TB diagnostic and treatment services.

          Results

          Systemic referral networks from the community-level Barangay Health Stations (BHSs) to diagnostic facilities have enabled more efficient detection of drug-sensitive tuberculosis in the public sector. Approximately 36% of patients initiated care in the private sector, where there is limited coverage of appropriate diagnostic technologies. Important differences in the alignment between care seeking patterns and diagnostic and treatment availability were found between regions.

          Conclusions

          The PPA identified opportunities for strengthening access to care for all forms of tuberculosis and for accelerating the time to diagnosis by aligning services to where patients initiate care. Geographic variations in care seeking may guide prioritization of some regions for intensified engagement with the private sector.

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          Most cited references2

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          Socio-economic determinants of knowledge and attitudes about tuberculosis among the general population of Metro Manila, Philippines.

          Five urban communities in Metro Manila with different socio-economic status. To investigate general knowledge about tuberculosis (TB) and intended health-seeking behaviour for TB symptoms among the general population of Metro Manila, and how they are determined by socioeconomic factors. Subjects aged 18 years and over were interviewed in a cross-sectional survey. Data on TB knowledge and intended health-seeking behaviour were stratified by sex, age, educational background, occupation, average family income and place of residence. A TB knowledge score was constructed based on 10 selected questions. Multivariate analysis with standard logistic regression showed those factors that were independently correlated to understanding of the disease, and to attitudes in case of TB symptoms. The TB knowledge score was also analysed by TB information source. Completed surveys were obtained from 3970 subjects. They scored low in general knowledge about TB (3.64 +/- 1.67, range 0-10). A higher score was independently associated with college education (OR = 4.35, 95%CI 6.60-2.87, P < 0.0001). There was no significant difference in TB knowledge acquired through several sources. No intention of seeking health care and intention to self-treat in case of TB disease were significantly correlated to low family monthly income (OR = 7.10, 95%CI 8.25-6.11, P < 0.0001 and OR = 1.74, 95%CI 2.06-1.46, P < 0.0001, respectively). Socio-economic factors should be taken into account in the design of TB information campaigns and in prioritising public health interventions about TB.
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            Market size and sales pattern of tuberculosis drugs in the Philippines.

            To identify the availability, types and quantity of anti-tuberculosis drugs in the public and private sectors from 2007 to 2011 in the Philippines.
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              Author and article information

              Journal
              J Infect Dis
              J. Infect. Dis
              jid
              The Journal of Infectious Diseases
              Oxford University Press (US )
              0022-1899
              1537-6613
              01 October 2017
              06 November 2017
              06 November 2017
              : 216
              : Suppl 7 , Using Patient Pathways to Accelerate the Drive to Ending Tuberculosis
              : S740-S747
              Affiliations
              [1 ] Department of Health of the Philippines, National Tuberculosis Program
              [2 ] Technical Assistance to Country project
              [3 ] World Health Organization, Office of the Philippines , Manila
              [4 ] Macalester College , St. Paul, Minnesota
              [5 ] Bill and Melinda Gates Foundation,
              [6 ] Linksbridge , Seattle, Washington.
              Author notes
              Correspondence: C. L. Hanson, PhD, Gates Foundation, 440 5th Ave N, Seattle, WA 98102 ( Christy.Hanson@ 123456gatesfoundation.org ).
              Article
              jix391
              10.1093/infdis/jix391
              5853338
              29117352
              59b06b82-0444-4940-aba2-bfb9625bea69
              © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

              This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

              History
              Page count
              Pages: 8
              Categories
              Supplement Articles

              Infectious disease & Microbiology
              tuberculosis,patient pathway analysis,mdr-tb,care seeking,diagnosis

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