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

Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Indonesia.
BMC Health Services Research (Impact Factor: 1.71). 05/2010; 10(1):113. DOI: 10.1186/1472-6963-10-113
Source: PubMed


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.
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.
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.
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.

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Available from: Anna-Karin Hurtig, Oct 08, 2015
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    • "The study participants generally indicated that the PPP approach has made positive contribution to TB control. Despite the importance of the private sector in TB control, sub-standardised DOTS treatment has been reported [35]. The inclusion of private sector in TB control therefore requires constant monitoring and supervision in order to assure and maintain standardised treatment. "
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    Archives of Public Health 08/2013; 71(1):22. DOI:10.1186/2049-3258-71-22
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    • "Indonesia is one example of an Asian country where DOTS is increasingly included within public and private hospitals [8-11]. Despite the successful scale-up, hospitals have reported lower cure and success rates, compared to chest clinics and health centres [8], with a large proportion of patients not treated with standardized diagnosis and treatment [9]. In order to strengthen integration of DOTS within hospitals, a combination of strong individual commitment of health professionals, organizational supports, partnership governance, and relevant policy is required [9]. "
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    • "By 2003 a strategy, known as Public-Private Mix DOTS (PPM DOTS), for engaging private providers in order to improve TB control had been established[10] and by 2006 was supported by the International Standards for TB Care[11]. During the subsequent few years the PPM DOTS concept expanded to encompass engagement with a range of providers, including some semi-qualified providers[12], traditional providers[13] and public and private hospitals[14,15]. PPM DOTS is now known as 'PPM for TB Care and Control' and is a core component of the WHO STOP TB Strategy, entitled 'Engage All Care Providers'[16] and supported by a toolkit to assist implementation[17]. "
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