Taiwan has integrated the previous vertical tuberculosis
(TB) control system into the general health care system. With the phase out of
the specialized TB care system and the declining TB incidence, it is likely
that clinical workers become less familiar with the presentation of TB,
resulting in delay in TB diagnosis and treatment.
We used the detailed information of health care visits in
the Taiwan National Health Insurance database to analyze the temporal pattern
of the health system delay (HSD) among 3,117 patients with TB between 2003 and
2010.
The median HSD was 29 days (interquartile range 5–73
days), and the median delay increased from 26 days in 2003 to
33.5 days in 2008, thereafter slightly decreased to 32 days in 2010.
Patient factors associated with a longer HSD included: aged 45–64 and ≧65 years (as compared to aged
<30 years); females
(as compared to males); an initial visit as an outpatient (as compared to an
inpatient). Provider factors were an initial visit to a provider not
specialized in TB (as compared to a TB-related provider), to a primary care
clinic or to a medical center (as compared to a district hospital), and in
Central region, Northern region, KaoPing region, Southern region and Taipei
region (as compared to in Eastern region). Longer distances from the point of
initial visit to that of treatment were associated with longer HSD. Patients
who switched among different levels or different types of medical care services
during their illness exhibited the longest HSD.
In countries where the TB care systems are being
restructured from a vertical to a horizontal system, it is critical to monitor
HSD and be aware of its increase. The potential increase in the HSD from 2003
to 2008 observed in this study is concerning and the decline of HSD after 2008
might be attributed to the launch of contact investigation. Our results call
for actions to improve the efficiency of TB diagnosis in the health care system
and to increase the awareness of TB among physicians and the general public.
Below: Incidence rate of
tuberculosis (TB) and health system delay (HSD): 2003–2010, Taiwan. a Annual TB incidence rate observed in the study cohort
(red line) compared with that reported by the Taiwan Centers for Disease
Control (CDC) (blue line), 2003–2010; b median HSD (solid line) and the corresponding Q1 (25th
percentile) and Q3 (75th percentile) of HSD (dashed lines) according to
calendar year
Full article
at:
1Institute of Epidemiology and Preventive
Medicine, National Taiwan University, Taipei, Taiwan
2Department of Lung Health and NCDs,
International Union Against Tuberculosis and Lung Disease, Paris, France
3Division of Pulmonary Medicine, Wan Fang
Hospital, Taipei Medical University, Taipei, Taiwan
4Department of Internal Medicine, College of
Medicine, Taipei Medical University, Taipei, Taiwan
5Department of Internal Medicine, National
Taiwan University Hospital, Taipei, Taiwan
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