Delay in diagnosis of pulmonary tuberculosis: a survey in the Lazio region, Italy

P. Pezzotti, S. Pozzato, E. Ferroni, V. Mazzocato, A. Altieri, G. Gualano, M. Loffredo, P. Napoli, F. Perrelli, E. Girardi
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引用次数: 10

Abstract

OBJECTIVE: To estimate patient and health care delays in the diagnosis of PTB and to evaluate associated factors. METHODS: PTB incident cases ≥18 years diagnosed between September 2010 and September 2011 in the Lazio region; information on symptoms and date of onset, health professionals contacts, diagnostic exams performed, and drugs prescribed before diagnosis were collected through a standardized questionnaire. The total delay (TD) was divided into patient delay (PD: from symptoms onset to first contact with healthcare services) and health system delay (HSD: from first contact to diagnosis). RESULTS: 278 cases were evaluated. Median PD,HSD, and TD, were 31, 15, and 77.5 days, respectively. The median PD, HSD, and TD were significantly lower in foreign born patients (26, 10.5, 63.5, vs. 45, 36, 100 days, respectively). Other factors independently associated with longer delay were: absence of fever and presence of weight loss for PD; prior unspecific treatment, absence of cough, consult with a general practitioner, visit to an outpatient clinic, and a PD <30 days for HSD. CONCLUSIONS: In Italy, the delay in TB diagnosis is similar to that estimated in other European countries. Results indicate that actions aimed to reduce diagnostic delay should be primarily addressed to Italian patients.
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肺结核诊断延误:意大利拉齐奥地区的一项调查
目的:评估PTB诊断中的患者和卫生保健延误,并评估相关因素。方法:2010年9月至2011年9月拉齐奥地区诊断≥18岁的肺结核病例;通过标准化问卷收集有关症状和发病日期、卫生专业人员接触、进行的诊断检查和诊断前开出的药物的信息。总延迟(TD)分为患者延迟(PD:从症状出现到首次接触医疗服务)和卫生系统延迟(HSD:从首次接触到诊断)。结果:共评估278例。中位PD、HSD和TD分别为31、15和77.5天。外国出生的患者PD、HSD和TD的中位值明显较低(分别为26、10.5、63.5天和45、36、100天)。与较长时间延迟独立相关的其他因素有:没有发烧和PD体重减轻;既往未接受特异性治疗,无咳嗽,咨询全科医生,去门诊就诊,HSD PD <30天。结论:在意大利,结核病诊断延误的估计与其他欧洲国家相似。结果表明,旨在减少诊断延误的行动应主要针对意大利患者。
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Epidemiology Biostatistics and Public Health
Epidemiology Biostatistics and Public Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
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期刊介绍: Epidemiology, Biostatistics, and Public Health (EBPH) is a multidisciplinary journal that has two broad aims: -To support the international public health community with publications on health service research, health care management, health policy, and health economics. -To strengthen the evidences on effective preventive interventions. -To advance public health methods, including biostatistics and epidemiology. EBPH welcomes submissions on all public health issues (including topics like eHealth, big data, personalized prevention, epidemiology and risk factors of chronic and infectious diseases); on basic and applied research in epidemiology; and in biostatistics methodology. Primary studies, systematic reviews, and meta-analyses are all welcome, as are research protocols for observational and experimental studies. EBPH aims to be a cross-discipline, international forum for scientific integration and evidence-based policymaking, combining the methodological aspects of epidemiology, biostatistics, and public health research with their practical applications.
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