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Int J Tuberc Lung Dis. 2012 Apr;16(4):510-5. doi: 10.5588/ijtld.11.0420.

Factors associated with patient and health care system delay in the diagnosis of tuberculosis in France.

Author information

1
Unité des Maladies Infectieuses et Réanimation Médicale, CHU Pontchaillou, Rennes, France. pierre.tattevin@chu-rennes.fr

Abstract

OBJECTIVE:

To analyse diagnostic delay in tuberculosis (TB) patients.

DESIGN:

Cross-sectional study: all patients with TB notified to the French national surveillance system from April to June 2010 were interviewed face-to-face using a standardised questionnaire to assess symptom history and health-seeking trajectories.

RESULTS:

Of 225 patients enrolled, 172 (76.4%) had pulmonary TB, including 88 who were smear-positive. Mean delay between first symptoms and diagnosis (total delay) was 97 days (median 68, IQR 33-111), with a mean of 47 days (median 14, IQR 0-53) between first symptoms and health care contact (patient delay), and 48 days (median 25, IQR 6-67) between health care contact and diagnosis (health system delay). Factors independently associated with shortened total delay were medical insurance (OR 0.24, P = 0.014) and previous TB (OR 0.28, P = 0.049). Those associated with reduced patient delay were initial fever (OR 0.42, P = 0.03) and being followed by a general practitioner (OR 0.22, P = 0.004), while those associated with reduced health system delay were first health care contact within a hospital (OR 0.15, P < 0.001). Empirical antibiotic treatment was associated with increased health system delay (OR 4.4, P = 0.001).

CONCLUSION:

TB diagnostic delay needs to be reduced in France. This may be achieved through improved access to care, earlier hospital referral, and less use of empirical antibiotic treatment.

PMID:
22325560
DOI:
10.5588/ijtld.11.0420
[Indexed for MEDLINE]

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