Journal
INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE
Volume 19, Issue 7, Pages 751-763Publisher
INT UNION AGAINST TUBERCULOSIS LUNG DISEASE (I U A T L D)
DOI: 10.5588/ijtld.15.0186
Keywords
TB; India; quality of care; International Standards for TB Care
Categories
Funding
- Grand Challenges Canada, Toronto, ON, Canada
- Bill and Melinda Gates Foundation, Seattle, WA, USA [OPP1091843]
- Canadian Thoracic Society, Ottawa, ON, Canada
- International Union Against Tuberculosis and Lung Disease, Paris, France
- Harvard (Cambridge, MA, USA) T32 HIV Post-doctoral Clinical Research Fellowship [NIAID AI007433]
- UCSF (University of California, San Francisco, CA, USA) T32 Post-doctoral Clinical Research Fellowship in Pulmonary and Critical Care Medicine [NHLBI 5T32HL007185]
- Fonds de recherche du Quebec - Sante, Montreal, QC, Canada
- Knowledge for Change Trust Fund at The World Bank
- Bill and Melinda Gates Foundation [OPP1091843] Funding Source: Bill and Melinda Gates Foundation
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BACKGROUND: While Indian studies have assessed care providers' knowledge and practices, there is no systematic review on the quality of tuberculosis (TB) care. METHODS: We searched multiple sources to identify studies (2000-2014) on providers' knowledge and practices. We used the International Standards for TB Care to benchmark quality of care. RESULTS: Of the 47 studies included, 35 were questionnaire surveys and 12 used chart abstraction. None assessed actual practice using standardised patients. Heterogeneity in the findings precluded meta-analysis. Of 22 studies evaluating provider knowledge about using sputum smears for diagnosis, 10 found that less than half of providers had correct knowledge; 3 of 4 studies assessing self-reported practices by providers SUMMARY found that less than a quarter reported ordering smears for patients with chest symptoms. In 11 of 14 studies that assessed treatment, less than one third of providers knew the standard regimen for drug-susceptible TB. Adherence to standards in practice was generally lower than correct knowledge of those standards. Eleven studies with both public and private providers found higher levels of appropriate knowledge/practice in the public sector. CONCLUSIONS: Available evidence suggests suboptimal quality of TB care, particularly in the private sector. Improvement of quality of care should be a priority for India.
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