Private patient perceptions about a public programme; what do private Indian tuberculosis patients really feel about directly observed treatmentReport as inadecuate




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BMC Public Health

, 10:357

First Online: 22 June 2010Received: 10 November 2009Accepted: 22 June 2010DOI: 10.1186-1471-2458-10-357

Cite this article as: Pinto, L.M. & Udwadia, Z.F. BMC Public Health 2010 10: 357. doi:10.1186-1471-2458-10-357

Abstract

BackgroundIndia accounts for one-fifth of the global incident cases of tuberculosisTB. The country presently has the world-s largest directly observed treatment, short course DOTS programme, that has shown impressive results and covers almost 100% of the billion-plus Indian population. Despite such a successful programme, the majority of Indian patients with tuberculosis prefer private healthcare, although repeated audits of this sector have shown the quality to be poor.

We aimed to ascertain the level of awareness and knowledge of private patients with tuberculosis attending our clinic at a tertiary private healthcare institute with regards to the DOTS programme, understanding the reasons behind their preference for private healthcare, and evaluating their perceptions and reasons for accepting or failing to accept directly observed therapy as a treatment option.

MethodsA structured interview schedule was administered to private patients with tuberculosis at the P.D. Hinduja Hospital and Medical Research Centre, Mumbai, India between January 2006 to November 2007.

ResultsOnly 30 of 200 patients 15% were aware of the DOTS programme. After being explained what directly observed therapy was, 136 patients 68% found this form of treatment unacceptable.183 patients 91.5% preferred buying the drugs themselves to visiting a DOTS centre. 90 patients 45% were not prepared to be observed while swallowing their TB drugs, finding it an intrusion of privacy.

ConclusionsOur study reveals a poor knowledge and awareness of the DOTS programme among the cohort of TB patients that we interviewed. The control of TB in India will undoubtedly benefit from more patients being attracted to and treated by the existing DOTS programmes. However, directly observed treatment, in its present form, is considered too rigid and intrusive and is unlikely to be accepted by a majority of patients seeking private healthcare. Novel strategies and more flexible options will have to be devised to ensure higher cure rates without compromising patient choice.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2458-10-357 contains supplementary material, which is available to authorized users.

Lancelot M Pinto and Zarir F Udwadia contributed equally to this work.

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Author: Lancelot M Pinto - Zarir F Udwadia

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