Factors Associated with Delay of Treatment among New Smear-Positive Pulmonary Tuberculosis Patients in Buengkan Province, Thailand

Abstract

This research was a crosssectional analytical study to determine the
factors associated with delays among newsmear–positive pulmonary tuberculosis
patients. Data were collected by facetoface interviews with a structured
questionnaires and the patients’medical records. The study was conducted
in the tuberculosis clinics at eight hospitals in Buengkan province between 1
October, 2014, and 30 September, 2015. For the data analyses, descriptive
statistics consisting of percentages, means, standard deviations, medians,
and interquartiles range (Q1 and Q3) were used to summarise patient
characteristics. A univariate analysis using the simple logistic regression was
performed to identify the factors associated with patient delay in treatment.
A multiple logistic regression analysis was performed to adjust for confounding
factors, adjusted OR (ORadj) and 95%CI were presented.
The results show that, in a total of 238 newsmearpositive pulmonary
tuberculosis patients, 21.47 (95%CI = 16.129.7) experienced patient delays
longer than 30 days, 19.7% were subject to health system delays longer than
7 days (95%CI=4.7–24.8). In the multivariate analysis, the factors significantly
associated with patient delay were patients with underlying diseases (ORadj=
3.14, 95%CI=1.39–7.10) behavior is high risk of infection (ORadj=6.27, 95%CI=
2.56–15.39), distance patients travel to hospitals that treat tuberculosis ≤16
km. (OR
adj=6.33, 95%CI=2.56–15.39), those who spend time more than 30
minutes to travel for treatment (OR
adj=11.05, 95%CI= 2.49–49.02) nobody
brought to hospital (ORadj=2.52, 95%CI=1.12–5.68). Factors significantly
associated with health system delays were seeing ≥≥3 medical doctors before
the diagnosis of tuberculosis (ORadj=6.58, 95%CI=1.61–26.85), the first facility
was a health centers, private clinic, pharmacies (ORadj=7.50, 95%CI=3.41–17.90)
From the results of this study, it is concluded that the factors associated
with treatment delays included the baseline characteristics of patients,
health behaviors, factors of travel, the baseline the results of treatment and
referral system. Therefore, break though performance diagnosis and
collaborative development in advance detection in patient with symptoms 
related tuberculosis or suspected tuberculosis patient themselves along
with taking the patient to the treatment as soon as possible to minimize
delays in treatment patient and reduce to occurs new patient