Perceptions of engagement in health care among patients with tuberculosis: a qualitative study

Free drug provision for tuberculosis increases patient follow-ups and successful treatment outcomes in the Indian private sector: a quasi experimental study using propensity score matching

BACKGROUND

The private sector is an important yet underregulated component of the TB treatment infrastructure in India. The Joint Effort for Elimination of Tuberculosis (Project JEET) aims to link private sector TB care with the constellation of social support mechanisms available through the Indian National TB Elimination Programme (NTEP), including the provision of free fixed-dose combination (FDCs) drugs to patients. This quasi-experimental study analysed routinely collected data to determine the impact of free drugs on patient follow-ups and treatment outcomes.

METHODS

We used data for private sector patients enrolled with Project JEET who were diagnosed with pulmonary and extrapulmonary TB between 1 and 2019 and 31 March 2020, and completed treatment by 31 December 2021. Propensity score matching was used to create a dataset to compare the number of follow-ups and proportion of successful treatment outcomes for patients on free drugs to a control group who paid out-of-pocket. 11,621 matched pairs were included in the analysis. Logistic regression and ordinary least squares regression models were used to estimate the impact of free drugs on number of follow-ups and treatment success, where latter is defined as treatment completion or cure.

RESULTS

After controlling for potential confounders, patients on free drugs received on average 2.522 (95% C.I.: 2.325 to 2.719) additional follow-ups compared to patients who paid out of pocket. This equates to a 25% mean and 32% median increase in follow-ups for patients availing free drugs. For treatment success, patients receiving free drugs had 45% higher odds of a successful treatment (Odds Ratio: 1.452, 95% C.I.: 1.288 to 1.637).

CONCLUSIONS

Patients receiving free drugs were found to follow up with their treatment coordinator more frequently, in part likely to enable drug refilling, compared to patients who were paying out of pocket. These additional contacts would have offered opportunities to address concerns regarding side effects, provide additional treatment information, and connect with social support services, all of which subsequently contributed to patients' continual engagement with their treatment. This potentially represents the unmeasured effect of free drugs on continual social support, which translates into a higher odds of treatment success for patients.

Effect of hospital attributes on patient preference among outpatient attendants in Wolaita Zone, Southern Ethiopia: discrete choice experiment study

BACKGROUND

Patient preference has preceded the use of health care services, and it has been affected by different hospital attributes. Meanwhile, the number of patients receiving vital health intervention is particularly low in Ethiopia. Therefore, this study aimed to determine the effect of hospital attributes on patient preference for outpatients in the Wolaita area in September 2020.

METHODS

A discrete choice experimental study was applied to determine the effect of hospital attributes on patient preference with a sample size of 1077. The experimental survey was conducted among outpatient attendants selected through a systematic random sampling approach. Six key attributes (competence of healthcare providers; availability of medical equipment and supplies; cost of service; wait time; distance; and hospital reputation) deduced from various hospital attributes were used to elicit the patient preferences. The data was collected from participants through the Open Data Kit application. A random effect probit model with marginal willingness to pay measure and partially log-likelihood analysis was applied to extract important attributes. We used STATA version 15 software for analysis, and the fitness of the model was verified by the calculated p-value for the Wald chi-square with a cut-point value of 0.05.

RESULT

One thousand forty-five patients who received outpatient care participated in the study. The random effect probit results have shown that all hospital attributes included in the study were significantly valued by patients while choosing the hospital (p-value < 0.001). Meanwhile, based on marginal willingness to pay and partial log-likelihood analysis, the competence of health care providers was identified as the most important attribute followed by the availability of medical equipment and supplies in hospitals.

CONCLUSION AND RECOMMENDATION

The results suggested that the quality of health care providers and availability of medical equipment and supply in hospitals would be primary interventional points for improving the patient preference of hospitals. Assessment, education, and training are recommended for enhancing the quality of health care providers. And stock balance checks, inspections, and accreditation are believed to be valuable for improving the availability of equipment and supply in hospitals.

Treatment Adherence among Tuberculosis patients: A Concept Analysis

BACKGROUND OF THE STUDY: The principal difficulty of long-term tuberculosis (TB) treatment is patient nonadherence. During pandemic, nonadherence of TB treatment affects mortality since TB patients are more vulnerable with Covid-19. AIM OF THE STUDY: The purpose of this concept analysis was to clarify and analyze the concept of treatment adherence. METHODOLOGY: Analysis concept was conducted using the Walker and Avant’s method from relevant studies published by EBSCO, PubMed, ProQuest, Wiley Online Library, and Springer between  2003 - 2021. RESULTS:  Five attributes characterizing the concept of treatment adherence from thirteen articles were identified: individual behavior, relationship, mutual participation, shared decision making, and agreement. CONCLUSION: This concept analysis revealed that TB treatment adherence involves many aspects, including the patient, family, society, health care professionals, and policy. These findings help to understand the contribution of major attributes, thereby promoting the body of knowledge on TB and contributing to its elimination during COVID-19 pandemic.

Development and Psychometric Testing of the Supportive Care Needs Scale for Patients with Tuberculosis (SCN-TB)

PURPOSE

Patients affected by tuberculosis have diverse unmet supportive care needs (SCN) that may seriously affect their treatment adherence. Accurately assessing patients' SCN is important for providing efficient patient-centred care, but few instruments are suitable for use in clinical practice. Therefore, the purpose of this study was to develop an SCN scale for patients with tuberculosis (SCN-TB) and to evaluate its psychometrical properties.

PATIENTS AND METHODS

Based on the SCN framework, the SCN-TB was designed via a literature review, Delphi consultation and pilot study. Then, 550 patients from four tuberculosis specialist hospitals in Shaanxi Province were enrolled by convenience sampling to further test the validity and reliability of the SCN-TB.

RESULTS

A total of 518 patients completed the survey. The final scale encompasses 25 items in five domains: physical, practical, psycho-emotional, social, and informational. The content validity for the scale was 0.93, with that for each item ranging from 0.80 to 1.00. Five factors that explained 80.38% of the variance were identified in exploratory factor analysis. A five-factor model was then confirmed with confirmatory factor analysis using maximum likelihood estimation with bootstrapping. The model fit indices were χ ²/df=1.062 (Bollen-Stine χ ²=281.382, df=265, p<0.001), CFI=0.997, RMSEA=0.016, SRMR=0.053, NFI=0.951, and GFI=0.929. All factors had acceptable convergent and discriminant validity. The Cronbach's α, split-half, and test-retest reliability coefficients of the scale were 0.884, 0.883, and 0.854, respectively.

CONCLUSION

The SCN-TB is a valid and reliable theory based tool for assessing the needs of patients with tuberculosis and can be applied in both clinical practice and research.

Role of Treatment Adherence, Doctor-Patient Trust, and Communication in Predicting Treatment Effects Among Tuberculosis Patients: Difference Between Urban and Rural Areas

PURPOSE

China is the second highest tuberculosis (TB) burden in the world, and TB patients in the rural areas are about twice as many as urban patients. The purpose of present study was to explore the roles of medication adherence, doctor-patient trust and communication on treatment effects, and its inequality between urban and rural areas.

METHODS

There were 564 eligible TB patients, from four tuberculosis hospitals in China, participating in this cross-sectional study. They filled out questionnaires regarding socio-demographic characteristics, medication adherence, treatment effect, doctor-patient trust, and communication. The structural equation model (SEM) was applied to explore the hypotheses in this study. All statistical analysis was done by SPSS 25.0 and Mplus 7.0 statistical software.

RESULTS

This study included 267 (47.34%) urban and 297 (52.66%) rural eligible TB patients. The data fitted the research model well, and the urban TB patients reported better treatment effect than the rural ones (P=0.027). Overall, treatment adherence positively predicted treatment effect (Est.=0.353, P<0.001); doctor-patient communication positively influenced treatment adherence (Est.=0.214, P=0.002); and treatment adherence positively mediated the role of communication on treatment effect (Est.=0.076), 95% CI (0.026, 0.152). While in the grouping model, the urban patients' treatment effect was only influenced by adherence (Est.=0.286, P=0.003); for the rural patients, treatment adherence (Est.=0.464, P<0.001) and doctor-patient trust (Est.=0.382, P=0.019) directly predicted treatment effects, and treatment adherence positively mediated the role of doctor-patient communication on treatment effect (Est.=0.175, P=0.006).

CONCLUSION

The treatment effect of TB patients, from urban and rural China, was influenced by a different mechanism, among which rural TB patients need not only improve the treatment adherence but also establish good doctor-patient trust and communication to improve treatment effects. These findings provided a theoretical guide on treatment and control for rural TB patients.