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Involving private practitioners in the Indian tuberculosis programme: a randomised trial
Author(s) -
Yellappa Vijayashree,
Battaglioli Tullia,
Gurum Sanath Kumar,
Narayanan Devadasan,
Van der Stuyft Patrick
Publication year - 2018
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.13053
Subject(s) - medicine , referral , confidence interval , randomized controlled trial , family medicine , pulmonary tuberculosis , sputum , tuberculosis , intervention (counseling) , physical therapy , nursing , pathology
Objectives To assess a multicomponent intervention to improve private practitioners ( PP s) involvement in referral of presumptive pulmonary TB ( PTB ) cases to the Revised National TB Control Programme ( RNTCP ) for sputum examination. Methods Randomised controlled trial. We randomly allocated all 189 eligible PP s in Tumkur city, South India, to intervention or control arm. The intervention, implemented between December 2014 and January 2016, included two sets of activities, one targeted at health system strengthening (building RNTCP staff capacity to collaborate with PP s, provision of feedback on referrals through SMS ) and one targeted at intervention PP s (training in RNTCP , provision of referral pads and education materials and monthly visits to PP s by RNTCP staff). Crude and adjusted referral and PTB case‐finding rate ratios were calculated with negative binomial regression. Results PP s referred 836 individuals (548 from intervention and 169 from control arm PP s) of whom 176 were diagnosed with bacteriologically confirmed PTB . The proportion (95% confidence interval) of referring PP s [0.59 (0.49, 0.68) vs . 0.42 (0.32, 0.52) in the intervention and control arm, respectively], mean referral rate per PP ‐year [(5.7 (3.8, 8.7) vs . 1.8 (1.2, 2.8)] and smear‐positive PTB case‐finding rate per PP ‐year [(1.5 (0.9, 2.2) vs . 0.6 (0.3, 0.9)] were significantly higher in the intervention than the control arm. Stratifying by qualification, a statistically significant difference in the above indicators remained only among GP s and internists. Overall, surgeons, paediatricians and gynaecologists referred few patients. PP referrals contributed to 20% of the sputum smear positive PTB cases detected by RNTCP in Tumkur city (14% were from intervention arm PP s). Conclusions We demonstrated the effectiveness of a health system‐oriented intervention to improve PP ’s referrals of presumptive PTB cases to RNTCP .