Abstract:
BACKGROUND:In 2011, South Africa improved its ability to test for rifampicin-resistant TB (RR-TB) by introducing GeneXpert MTB/RIF. At the same time, the South African National TB program adopted a policy decentralized, outpatient treatment for drug resistant (DR-) TB. We aim to analyze the impact of these changes on linkage to care and DR-TB treatment outcomes. METHODS:We retrospectively matched adult patients diagnosed with laboratory-confirmed RR-TB in Johannesburg from 07/2011-06/2012 (early cohort) and 07/2013-06/2014 (late cohort) with records of patients initiating DR-TB treatment at one of the city's four public sector treatment sites. We determine the proportion of persons diagnosed with RR-TB who initiated DR-TB treatment and report time to treatment initiation (TTI) before and after the implementation of Xpert MTB/RIF roll-out in Johannesburg, South Africa. We conducted a sub-analysis among those who initiated DR-TB treatment at the decentralized outpatient DR-TB centers to determine if delays in treatment initiation have a subsequent impact on treatment outcomes. RESULTS:Five hundred ninety four patients were enrolled in the early cohort versus 713 in the late cohort. 53.8 and 36.8% of patients were diagnosed with multi-drug resistant TB in the early and late cohorts, respectively. The proportion of RR-TB confirmed cases diagnosed by Xpert MTB/RIF increased from 43.4 to 60.5% between the early and late cohorts, respectively. The proportion who initiated treatment increased from 43.1% (n = 256) to 60.3% (n = 430) in the late cohort. Pre-treatment mortality during the early and the late cohort reduced significantly from 17.5 to 5.8% while lost to follow-up remained high. Although TTI reduced by a median of 19 days, from 33 days (IQR 12-52) in the early cohort to 14 days (IQR 7-31) in the late cohort, this did not translate to improved treatment outcomes and we found no difference in terms of treatment success or on-treatment mortality for those that initiated without delay vs. those that deferred initiation. CONCLUSION:Pre-treatment mortality reduced significantly during late Xpert MTB/RIF coverage but there was no significant difference after treatment was initiated. Despite improvements there is still a significant diagnosis and treatment gap for patients diagnosed with RR-TB and improving treatment outcomes remains critical.
journal_name
BMC Health Serv Resjournal_title
BMC health services researchauthors
Evans D,Sineke T,Schnippel K,Berhanu R,Govathson C,Black A,Long L,Rosen Sdoi
10.1186/s12913-018-3762-xsubject
Has Abstractpub_date
2018-12-17 00:00:00pages
973issue
1issn
1472-6963pii
10.1186/s12913-018-3762-xjournal_volume
18pub_type
杂志文章,多中心研究abstract:BACKGROUND:The burden of arthritis is increasing in the face of diminishing health human resources to deliver care. In response, innovative models of care delivery are developing to facilitate access to quality care. Most models have developed in response to local needs with limited evaluation. The primary objective of...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-8-147
更新日期:2008-07-14 00:00:00
abstract:BACKGROUND:Blood borne infectious agents such as hepatitis B virus (HBV), hepatitis C virus (HCV) and human immune deficiency virus (HIV) constitute a major occupational hazard for healthcare workers (HCWs). To some degree it is inevitable that HCWs sustain injuries from sharp objects such as needles, scalpels and spli...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-13-276
更新日期:2013-07-17 00:00:00
abstract:BACKGROUND:Patients with type 2 diabetes (T2DM) often have poor glycemic control on first-line pharmacologic therapy and require treatment intensification. Intensification decisions can be difficult because of many available options and their many benefits and risks. The American Diabetes Association recommends patient...
journal_title:BMC health services research
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1186/s12913-016-1262-4
更新日期:2016-01-14 00:00:00
abstract:BACKGROUND:Magnetic resonance imaging (MRI) of the knee is the second most common MRI examination in Norway after head/brain MRI. Little has been published internationally on trends in the use of knee MRI after 1999. This study aimed to describe levels and trends in ambulant knee MRI utilisation in Norway 2002-2004 in ...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-7-115
更新日期:2007-07-22 00:00:00
abstract:BACKGROUND:Japan has the highest rate of aging. To contain Long-Term Care (LTC) Insurance costs, the Japanese government is attempting to increase the proportion of individuals receiving home care services. However, demand for institutional care is increasing. These circumstances will decrease the sustainability of the...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-017-2293-1
更新日期:2017-05-15 00:00:00
abstract:BACKGROUND:To examine the association between rurality and health in Scotland, after adjusting for differences in individual and practice characteristics. METHODS: DESIGN:Mortality and hospital record data linked to two cross sectional health surveys. SETTING:Respondents in the community-based 1995 and 1998 Scottish...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-12-43
更新日期:2012-02-17 00:00:00
abstract:BACKGROUND:Outreach facilitation has been proven successful in improving the adoption of clinical preventive care guidelines in primary care practice. The net costs and savings of delivering such an intensive intervention need to be understood. We wanted to estimate the proportion of a facilitation intervention cost th...
journal_title:BMC health services research
pub_type: 杂志文章,随机对照试验
doi:10.1186/1472-6963-5-20
更新日期:2005-03-09 00:00:00
abstract:BACKGROUND:Persons with schizophrenia and related disorders may be particularly sensitive to a number of determinants of service use, including those related with illness, socio-demographic characteristics and organizational factors. The objective of this study is to identify factors associated with outpatient contacts...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-11-257
更新日期:2011-10-07 00:00:00
abstract:BACKGROUND:There are no empirically-grounded criteria or tools to define or benchmark the quality of outpatient clinical documentation. Outpatient clinical notes document care, communicate treatment plans and support patient safety, medical education, medico-legal investigations and reimbursement. Accurately describing...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-12-407
更新日期:2012-11-19 00:00:00
abstract:BACKGROUND:The functional split model of consultant psychiatrist care for inpatients has been one of the major service redesign that has occurred in the NHS in the last decade. It is unclear if this new split model offers any advantages over the previous sectorised model of working. More recent evidence has suggested t...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-13-362
更新日期:2013-09-27 00:00:00
abstract:BACKGROUND:Implementation of interventions concerning prevention and health promotion in health care has faced particular challenges resulting in a low frequency and quality of these services. In November 2011, the Swedish National Board of Health and Welfare released national clinical practice guidelines to counteract...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-018-3023-z
更新日期:2018-04-02 00:00:00
abstract:BACKGROUND:The current, place-oriented nurse call systems are very static. A patient can only make calls with a button which is fixed to a wall of a room. Moreover, the system does not take into account various factors specific to a situation. In the future, there will be an evolution to a mobile button for each patien...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-11-26
更新日期:2011-02-04 00:00:00
abstract:BACKGROUND:Healthcare systems are increasingly focusing on outcomes that are the endpoints of care: patient health status and patient satisfaction. The availability of patient satisfaction (PS) data has encouraged research on its relationship with other outcomes, such as mortality. In Italy, an inter-regional performan...
journal_title:BMC health services research
pub_type: 杂志文章,多中心研究
doi:10.1186/s12913-018-2846-y
更新日期:2018-01-29 00:00:00
abstract:BACKGROUND:Wellbeing of healthcare workers is important for the effective functioning of health systems. The aim of this study was to explore the conceptualisations of wellbeing, stress and burnout among healthcare workers in primary healthcare settings in rural Ethiopia in order to inform the development of contextual...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-017-2370-5
更新日期:2017-06-19 00:00:00
abstract:BACKGROUND:Clinical social franchising is a rapidly growing delivery model in private healthcare markets in low- and middle-income countries. Despite this growth, little is known about providers' perceptions of the benefits and challenges of social franchising or clients' reasons for choosing franchised facilities over...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-015-0709-3
更新日期:2015-02-01 00:00:00
abstract:BACKGROUND:Medical devices and in vitro diagnostic tests (IVD) are vital components of health delivery systems but access to these important tools is often limited in Africa. The regulation of health commodities by National Regulatory Authorities is intended to ensure their safety and quality whilst ensuring timely acc...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-014-0524-2
更新日期:2014-10-31 00:00:00
abstract:BACKGROUND:Hospitalized patients are designated alternate level of care (ALC) when they no longer require hospitalization but discharge is delayed while they await alternate disposition or living arrangements. We assessed hospital costs and complications for general internal medicine (GIM) inpatients who had delayed di...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-019-4760-3
更新日期:2019-12-04 00:00:00
abstract:BACKGROUND:Common mental disorders are the most prevalent of all mental disorders, with the highest burden in terms of work absenteeism and utilization of health care services. Evidence-based treatments are available, but recognition and treatment could be improved, especially in the occupational health setting. The si...
journal_title:BMC health services research
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1186/1472-6963-7-29
更新日期:2007-02-27 00:00:00
abstract:BACKGROUND:Research shows us that auditory hallucinations or 'hearing voices' may be more common than previously thought, particularly in childhood and adolescents. Importantly, not all individuals are affected negatively by their voice hearing experiences, yet child and adolescent mental health services (CAMHS) have t...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-014-0527-z
更新日期:2014-11-05 00:00:00
abstract:BACKGROUND:Despite the demonstrated need to increase screening mammography utilization and strong evidence that mail and telephone outreach to women can increase screening, most managed care organizations have not adopted comprehensive outreach programs. The uncertainty about optimum strategies and cost effectiveness h...
journal_title:BMC health services research
pub_type: 杂志文章,随机对照试验
doi:10.1186/1472-6963-11-145
更新日期:2011-06-03 00:00:00
abstract:BACKGROUND:There is a trend towards value-based health service, striving to cut costs while generating value for the patient. The overall objective comprises higher-quality health services and improved patient safety and cost efficiency. The approach could align with patient-centred care, as it entails a focus on the p...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-016-1957-6
更新日期:2017-01-11 00:00:00
abstract:BACKGROUND:Professional networks are used increasingly in health care to bring together members from different sites and professions to work collaboratively. Key players within these networks are known to affect network function through their central or brokerage position and are therefore of interest to those who seek...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-13-338
更新日期:2013-08-30 00:00:00
abstract:BACKGROUND:In the management of chronic disease, evidence suggests that satisfied patients exhibit more loyalty to treatment providers and greater adherence to treatment regimens. This is particularly so in the rehabilitation setting. We aimed to develop a reliable and valid Arabic-language survey to objectively measur...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-017-2596-2
更新日期:2017-09-18 00:00:00
abstract:BACKGROUND:Attempts to reduce high utilisation of psychiatric inpatient care by targeting the critical time of hospital discharge have been rare. METHODS:This paper presents design and methods of the study "Effectiveness and Cost-Effectiveness of Needs-Oriented Discharge Planning and Monitoring for High Utilisers of P...
journal_title:BMC health services research
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1186/1472-6963-8-152
更新日期:2008-07-21 00:00:00
abstract:BACKGROUND:Among the important stress factors for physicians nowadays are poorly functioning, time consuming and inadequate information systems. The present study examined the predictors of physicians' stress related to information systems (SRIS) among Finnish physicians. The examined predictors were cognitive workload...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-018-3094-x
更新日期:2018-04-13 00:00:00
abstract:BACKGROUND:The implementation of strategic health system change is often complicated by the informal politics and power of health systems, such as competing interests and resistant groups. Evidence from other industries shows that strategic leaders need to be aware of and manage such 'organisational politics' when impl...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-018-3728-z
更新日期:2018-12-03 00:00:00
abstract:BACKGROUND:Most existing research on medical clowns in health care services has investigated their usefulness mainly among child health consumers. In this research we examined multiple viewpoints of medical staff, clowns, and health consumers aiming to identify the optimal audience (adult or child health consumers) for...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-020-05987-9
更新日期:2021-01-06 00:00:00
abstract:BACKGROUND:Recently arrived culturally and linguistically diverse migrant mothers in Western Industrialised Nations are less likely to access health care and are more likely to report negative healthcare experiences than more established migrant or non-migrant populations. This is particularly an issue in Australia whe...
journal_title:BMC health services research
pub_type: 杂志文章,评审
doi:10.1186/s12913-020-05157-x
更新日期:2020-04-15 00:00:00
abstract:BACKGROUND:There are few studies comparing pharmaceutical costs and the use of medications between immigrants and the autochthonous population in Spain. The objective of this study is to evaluate whether there are differences in pharmaceutical consumption and expenses between immigrant and Spanish-born populations. ME...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-8-35
更新日期:2008-02-06 00:00:00
abstract:BACKGROUND:People experiencing homelessness and mental illness face multiple barriers to care. The goal of this study was to examine the association between health service use and indicators of need among individuals experiencing homelessness and mental illness in Vancouver, Canada. We hypothesized that those with more...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-14-404
更新日期:2014-09-18 00:00:00