GUADALAJARA, Mexico – One after another, patients came to clinics and hospitals in rural China complaining of alarming, nagging and debilitating symptoms. They noted coughs and fevers that didn’t go away, and that they were losing weight for no apparent reason.
Their symptoms should have sounded familiar in the health centers of a country with one of the highest rates of tuberculosis in the world, but according to data presented in a last day plenary talk here, fewer than half of them were referred for a test that would have detected the disease, and more than half were referred for inappropriate treatment.
The findings were in line with similar data from rural and urban health facilities in India and in Kenya, Dr. Madhukar Pai of McGill University said. All of the findings underscored, he added, that even when people with symptoms suggesting tuberculosis overcome their own dread, along with the obstacles of lost work time and costs of travel to a clinic, the competence of the care they find may still stand between them and the treatment they need.
In studies collecting the data in all three countries the patients were actors playing a part — describing standard symptoms that should have led health staff to at least send them for sputum tests and chest X-rays. If they had been real patients with real illnesses the “long pathway to care,” Dr. Pai said, would have been stretched, for more than 60 percent of them, by gaps in the quality of services.
Attention to quality, and efforts to ensure competent services in both public and private tuberculosis settings is not new, Dr. Pai noted. “It has worked in India, and if it can work in India, it can work anyplace in the world,” he added.
But around the world, in some of the most heavily burdened countries, most national tuberculosis programs are just “beginning to flirt with quality improvement” he said. They will need to consider steps such as the studies he described to determine if guidelines are being followed, if proven interventions are being provided, and if patients that cross the hurdles to care are getting the care they need, he noted.
“We’ve got to ask ourselves, how good is the care we’re giving to our patients,” Dr. Pai said, “and are we willing to measure it.”
For more on the studies and the topic, see www.qutubproject.org