China tuberculosis policy at crucial crossroads: comparing the practice of different hospital and tuberculosis control collaboration models using survey data
Currently three hospital and tuberculosis (TB) collaboration models exist in China: the dispensary model where TB has to be diagnosed and treated in TB dispensaries, the specialist model where TB specialist hospital also treat TB patients, and the integrated model where TB diagnosis and treatment is...
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| Veröffentlicht in: | PloS one 2014-03, Vol.9 (3), p.e90596-e90596 |
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| creator | Wei, Xiaolin Zou, Guanyang Walley, John Yin, Jia Lonnroth, Knut Uplekar, Mukund Wang, Weibing Sun, Qiang |
| description | Currently three hospital and tuberculosis (TB) collaboration models exist in China: the dispensary model where TB has to be diagnosed and treated in TB dispensaries, the specialist model where TB specialist hospital also treat TB patients, and the integrated model where TB diagnosis and treatment is integrated into a general hospital. The study compared effects of the three models through exploring patient experience in TB diagnosis and treatment.
We selected two sites in each model of TB service in four provinces of China. In each site, 50 patients were selected from TB patient registries for a structured questionnaire survey, with a total of 293 patients recruited. All participants were newly registered uncomplicated TB cases without any major complications or resistance to first-line anti-TB drugs, and having successfully completed treatment. Diagnostic and treatment procedures were reviewed from medical charts of the surveyed patients to compare with national guidelines.
Specialist sites had the highest patient expenditure, hospitalization rates and mostly used second-line anti-TB drugs, while the integrated model reported the opposite. The median health expenditure was USD 1,499 for the specialist sites and USD 306 for the integrated sites, with 83% and 15% patients respectively having unnecessary hospitalization. 74% of the specialist sites and 19% of the integrated sites used second-line anti-TB drugs. Mixed results were identified in the two dispensary sites. One site had median health expenditure of USD 138 with 12% of patients hospitalized, while the other had USD 912 and 65% respectively.
The study observed prohibitive financial expenditure and a high level of deviation from national guidelines in all sites, which may be related to the profit-seeking behavior of public hospitals. The study supports the integrated model as the better policy option for future TB health reform in China. |
| doi_str_mv | 10.1371/journal.pone.0090596 |
| format | Article |
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We selected two sites in each model of TB service in four provinces of China. In each site, 50 patients were selected from TB patient registries for a structured questionnaire survey, with a total of 293 patients recruited. All participants were newly registered uncomplicated TB cases without any major complications or resistance to first-line anti-TB drugs, and having successfully completed treatment. Diagnostic and treatment procedures were reviewed from medical charts of the surveyed patients to compare with national guidelines.
Specialist sites had the highest patient expenditure, hospitalization rates and mostly used second-line anti-TB drugs, while the integrated model reported the opposite. The median health expenditure was USD 1,499 for the specialist sites and USD 306 for the integrated sites, with 83% and 15% patients respectively having unnecessary hospitalization. 74% of the specialist sites and 19% of the integrated sites used second-line anti-TB drugs. Mixed results were identified in the two dispensary sites. One site had median health expenditure of USD 138 with 12% of patients hospitalized, while the other had USD 912 and 65% respectively.
The study observed prohibitive financial expenditure and a high level of deviation from national guidelines in all sites, which may be related to the profit-seeking behavior of public hospitals. The study supports the integrated model as the better policy option for future TB health reform in China.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0090596</identifier><identifier>PMID: 24621996</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adult ; China ; Clinics ; Collaboration ; Communicable Disease Control - economics ; Communicable Disease Control - statistics & numerical data ; Cooperation ; Cooperative Behavior ; Costs ; Data Collection ; Drug resistance ; Female ; Health care costs ; Health care reform ; Health Policy - economics ; Health services ; Hospitalization ; Hospitals ; Hospitals - statistics & numerical data ; Humans ; Lung diseases ; Male ; Medical diagnosis ; Medical research ; Medicine ; Middle Aged ; Models, Statistical ; Primary care ; Provinces ; Public health ; Surveys ; Tuberculosis ; Tuberculosis - drug therapy ; Tuberculosis - economics ; Tuberculosis - prevention & control ; Tuberculosis - therapy</subject><ispartof>PloS one, 2014-03, Vol.9 (3), p.e90596-e90596</ispartof><rights>COPYRIGHT 2014 Public Library of Science</rights><rights>2014 Wei et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2014 Wei et al 2014 Wei et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-db60d44e4235ba20471518c226b572a518da929f999bdcdcd0371f290639f0783</citedby><cites>FETCH-LOGICAL-c692t-db60d44e4235ba20471518c226b572a518da929f999bdcdcd0371f290639f0783</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3951218/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3951218/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24621996$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Neyrolles, Olivier</contributor><creatorcontrib>Wei, Xiaolin</creatorcontrib><creatorcontrib>Zou, Guanyang</creatorcontrib><creatorcontrib>Walley, John</creatorcontrib><creatorcontrib>Yin, Jia</creatorcontrib><creatorcontrib>Lonnroth, Knut</creatorcontrib><creatorcontrib>Uplekar, Mukund</creatorcontrib><creatorcontrib>Wang, Weibing</creatorcontrib><creatorcontrib>Sun, Qiang</creatorcontrib><title>China tuberculosis policy at crucial crossroads: comparing the practice of different hospital and tuberculosis control collaboration models using survey data</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Currently three hospital and tuberculosis (TB) collaboration models exist in China: the dispensary model where TB has to be diagnosed and treated in TB dispensaries, the specialist model where TB specialist hospital also treat TB patients, and the integrated model where TB diagnosis and treatment is integrated into a general hospital. The study compared effects of the three models through exploring patient experience in TB diagnosis and treatment.
We selected two sites in each model of TB service in four provinces of China. In each site, 50 patients were selected from TB patient registries for a structured questionnaire survey, with a total of 293 patients recruited. All participants were newly registered uncomplicated TB cases without any major complications or resistance to first-line anti-TB drugs, and having successfully completed treatment. Diagnostic and treatment procedures were reviewed from medical charts of the surveyed patients to compare with national guidelines.
Specialist sites had the highest patient expenditure, hospitalization rates and mostly used second-line anti-TB drugs, while the integrated model reported the opposite. The median health expenditure was USD 1,499 for the specialist sites and USD 306 for the integrated sites, with 83% and 15% patients respectively having unnecessary hospitalization. 74% of the specialist sites and 19% of the integrated sites used second-line anti-TB drugs. Mixed results were identified in the two dispensary sites. One site had median health expenditure of USD 138 with 12% of patients hospitalized, while the other had USD 912 and 65% respectively.
The study observed prohibitive financial expenditure and a high level of deviation from national guidelines in all sites, which may be related to the profit-seeking behavior of public hospitals. The study supports the integrated model as the better policy option for future TB health reform in China.</description><subject>Adult</subject><subject>China</subject><subject>Clinics</subject><subject>Collaboration</subject><subject>Communicable Disease Control - economics</subject><subject>Communicable Disease Control - statistics & numerical data</subject><subject>Cooperation</subject><subject>Cooperative Behavior</subject><subject>Costs</subject><subject>Data Collection</subject><subject>Drug resistance</subject><subject>Female</subject><subject>Health care costs</subject><subject>Health care reform</subject><subject>Health Policy - economics</subject><subject>Health services</subject><subject>Hospitalization</subject><subject>Hospitals</subject><subject>Hospitals - statistics & numerical data</subject><subject>Humans</subject><subject>Lung diseases</subject><subject>Male</subject><subject>Medical diagnosis</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Middle Aged</subject><subject>Models, Statistical</subject><subject>Primary care</subject><subject>Provinces</subject><subject>Public health</subject><subject>Surveys</subject><subject>Tuberculosis</subject><subject>Tuberculosis - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wei, Xiaolin</au><au>Zou, Guanyang</au><au>Walley, John</au><au>Yin, Jia</au><au>Lonnroth, Knut</au><au>Uplekar, Mukund</au><au>Wang, Weibing</au><au>Sun, Qiang</au><au>Neyrolles, Olivier</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>China tuberculosis policy at crucial crossroads: comparing the practice of different hospital and tuberculosis control collaboration models using survey data</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2014-03-12</date><risdate>2014</risdate><volume>9</volume><issue>3</issue><spage>e90596</spage><epage>e90596</epage><pages>e90596-e90596</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Currently three hospital and tuberculosis (TB) collaboration models exist in China: the dispensary model where TB has to be diagnosed and treated in TB dispensaries, the specialist model where TB specialist hospital also treat TB patients, and the integrated model where TB diagnosis and treatment is integrated into a general hospital. The study compared effects of the three models through exploring patient experience in TB diagnosis and treatment.
We selected two sites in each model of TB service in four provinces of China. In each site, 50 patients were selected from TB patient registries for a structured questionnaire survey, with a total of 293 patients recruited. All participants were newly registered uncomplicated TB cases without any major complications or resistance to first-line anti-TB drugs, and having successfully completed treatment. Diagnostic and treatment procedures were reviewed from medical charts of the surveyed patients to compare with national guidelines.
Specialist sites had the highest patient expenditure, hospitalization rates and mostly used second-line anti-TB drugs, while the integrated model reported the opposite. The median health expenditure was USD 1,499 for the specialist sites and USD 306 for the integrated sites, with 83% and 15% patients respectively having unnecessary hospitalization. 74% of the specialist sites and 19% of the integrated sites used second-line anti-TB drugs. Mixed results were identified in the two dispensary sites. One site had median health expenditure of USD 138 with 12% of patients hospitalized, while the other had USD 912 and 65% respectively.
The study observed prohibitive financial expenditure and a high level of deviation from national guidelines in all sites, which may be related to the profit-seeking behavior of public hospitals. The study supports the integrated model as the better policy option for future TB health reform in China.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>24621996</pmid><doi>10.1371/journal.pone.0090596</doi><tpages>e90596</tpages><oa>free_for_read</oa></addata></record> |
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| issn | 1932-6203 1932-6203 |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adult China Clinics Collaboration Communicable Disease Control - economics Communicable Disease Control - statistics & numerical data Cooperation Cooperative Behavior Costs Data Collection Drug resistance Female Health care costs Health care reform Health Policy - economics Health services Hospitalization Hospitals Hospitals - statistics & numerical data Humans Lung diseases Male Medical diagnosis Medical research Medicine Middle Aged Models, Statistical Primary care Provinces Public health Surveys Tuberculosis Tuberculosis - drug therapy Tuberculosis - economics Tuberculosis - prevention & control Tuberculosis - therapy |
| title | China tuberculosis policy at crucial crossroads: comparing the practice of different hospital and tuberculosis control collaboration models using survey data |
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