Treatment as diagnosis and diagnosis as treatment: empirical management of presumptive tuberculosis in India
BACKGROUND: Mismanagement of TB is a concern in the Indian private sector, and empirical management might be a key contributor.OBJECTIVE: To understand factors associated with empirical diagnosis and treatment of presumed TB in India's private sector and examine their effects on TB care.DESIGN:...
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| Veröffentlicht in: | The international journal of tuberculosis and lung disease 2016-04, Vol.20 (4), p.536-543 |
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| container_title | The international journal of tuberculosis and lung disease |
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| creator | McDowell, A. Pai, M. |
| description | BACKGROUND: Mismanagement of TB is a concern in the Indian private sector, and empirical management might be a key contributor.OBJECTIVE: To understand factors associated with empirical diagnosis and treatment of presumed TB in India's private sector and examine their effects on
TB care.DESIGN: In this ethnographic study, 110 private practitioners of varying qualification who interacted with TB patients (90 in Mumbai and 20 in Patna) were interviewed, and a subset was observed while providing clinical care. Interviews and observations were analysed for indicators
of empirical diagnosis and treatment.RESULTS: All non-specialist practitioners began antibiotic treatment, especially quinolones, for persistent cough before prescribing a test. Several factors contribute to empirical management. These include a common practice use of medications as diagnostic
tools, a desire to provide rapid symptom relief to patients, a desire to manage illness costs effectively, uncertainty about the presentation of TB, the effects of broad spectrum antibiotics on TB symptomology, and uncertainty about the accuracy of available TB tests.CONCLUSION: Empiricism
in general and in TB care is widespread in the urban private sector in India. Ethnography might offer useful insights for addressing this in public-private mix models. |
| doi_str_mv | 10.5588/ijtld.15.0562 |
| format | Article |
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TB care.DESIGN: In this ethnographic study, 110 private practitioners of varying qualification who interacted with TB patients (90 in Mumbai and 20 in Patna) were interviewed, and a subset was observed while providing clinical care. Interviews and observations were analysed for indicators
of empirical diagnosis and treatment.RESULTS: All non-specialist practitioners began antibiotic treatment, especially quinolones, for persistent cough before prescribing a test. Several factors contribute to empirical management. These include a common practice use of medications as diagnostic
tools, a desire to provide rapid symptom relief to patients, a desire to manage illness costs effectively, uncertainty about the presentation of TB, the effects of broad spectrum antibiotics on TB symptomology, and uncertainty about the accuracy of available TB tests.CONCLUSION: Empiricism
in general and in TB care is widespread in the urban private sector in India. Ethnography might offer useful insights for addressing this in public-private mix models.</description><identifier>ISSN: 1027-3719</identifier><identifier>EISSN: 1815-7920</identifier><identifier>DOI: 10.5588/ijtld.15.0562</identifier><identifier>PMID: 26970165</identifier><language>eng</language><publisher>France: International Union Against Tuberculosis and Lung Disease</publisher><subject>Disease Management ; Empiric Management ; Empirical Research ; Fluoroquinolones ; Humans ; India ; Mycobacterium ; Physicians ; Practice Patterns, Physicians ; Private Practice ; Private Sector ; Tuberculosis ; Tuberculosis - diagnosis ; Tuberculosis - therapy</subject><ispartof>The international journal of tuberculosis and lung disease, 2016-04, Vol.20 (4), p.536-543</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c461t-cdc5934594b5f1124f73688bcfb00ec150b59d02f1de4545ab66ae1812cf787b3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26970165$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>McDowell, A.</creatorcontrib><creatorcontrib>Pai, M.</creatorcontrib><title>Treatment as diagnosis and diagnosis as treatment: empirical management of presumptive tuberculosis in India</title><title>The international journal of tuberculosis and lung disease</title><addtitle>Int J Tuberc Lung Dis</addtitle><description>BACKGROUND: Mismanagement of TB is a concern in the Indian private sector, and empirical management might be a key contributor.OBJECTIVE: To understand factors associated with empirical diagnosis and treatment of presumed TB in India's private sector and examine their effects on
TB care.DESIGN: In this ethnographic study, 110 private practitioners of varying qualification who interacted with TB patients (90 in Mumbai and 20 in Patna) were interviewed, and a subset was observed while providing clinical care. Interviews and observations were analysed for indicators
of empirical diagnosis and treatment.RESULTS: All non-specialist practitioners began antibiotic treatment, especially quinolones, for persistent cough before prescribing a test. Several factors contribute to empirical management. These include a common practice use of medications as diagnostic
tools, a desire to provide rapid symptom relief to patients, a desire to manage illness costs effectively, uncertainty about the presentation of TB, the effects of broad spectrum antibiotics on TB symptomology, and uncertainty about the accuracy of available TB tests.CONCLUSION: Empiricism
in general and in TB care is widespread in the urban private sector in India. Ethnography might offer useful insights for addressing this in public-private mix models.</description><subject>Disease Management</subject><subject>Empiric Management</subject><subject>Empirical Research</subject><subject>Fluoroquinolones</subject><subject>Humans</subject><subject>India</subject><subject>Mycobacterium</subject><subject>Physicians</subject><subject>Practice Patterns, Physicians</subject><subject>Private Practice</subject><subject>Private Sector</subject><subject>Tuberculosis</subject><subject>Tuberculosis - diagnosis</subject><subject>Tuberculosis - therapy</subject><issn>1027-3719</issn><issn>1815-7920</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFks2P1CAUwInRuOvq0avh6KUjj5ZCvZnVXTfZxJisZ0IpTJi0tPKxyfrXSzszxosRDnzk937AeyD0FsiOMSE-uEMahx2wHWEtfYYuQQCreEfJ8zInlFc1h-4CvYrxQAgFAP4SXdC24wRadonGh2BUmoxPWEU8OLX3c3QRKz_8vYo4nbmP2EyLC06rEU_Kq73ZomeLl2BinpbkHg1OuTdB53ELdx7f-WJ7jV5YNUbz5jReoR83Xx6uv1b3327vrj_dV7ppIVV60KyrG9Y1PbMAtLG8boXote0JMRoY6Vk3EGphMA1rmOrbVpnycKotF7yvr9D7o3cJ889sYpKTi9qMo_JmzlGCIIJTKAf8H-W8pqVDV9DqiOowxxiMlUtwkwpPEohcayG3Wkhgcq1F4d-d1LmfzPCHPie_AJ-PgPP7kkIlD3MOviRGuqxW09FHCyzJ1ig5TUgjVUjbTtF8_5dGn03rT1g_gnykxDdFSYEIyspdi2kwVuUxyaSC3P-SsTh_A6bct_g</recordid><startdate>20160401</startdate><enddate>20160401</enddate><creator>McDowell, A.</creator><creator>Pai, M.</creator><general>International Union Against Tuberculosis and Lung Disease</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7QL</scope><scope>C1K</scope></search><sort><creationdate>20160401</creationdate><title>Treatment as diagnosis and diagnosis as treatment: empirical management of presumptive tuberculosis in India</title><author>McDowell, A. ; Pai, M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c461t-cdc5934594b5f1124f73688bcfb00ec150b59d02f1de4545ab66ae1812cf787b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Disease Management</topic><topic>Empiric Management</topic><topic>Empirical Research</topic><topic>Fluoroquinolones</topic><topic>Humans</topic><topic>India</topic><topic>Mycobacterium</topic><topic>Physicians</topic><topic>Practice Patterns, Physicians</topic><topic>Private Practice</topic><topic>Private Sector</topic><topic>Tuberculosis</topic><topic>Tuberculosis - diagnosis</topic><topic>Tuberculosis - therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>McDowell, A.</creatorcontrib><creatorcontrib>Pai, M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Environmental Sciences and Pollution Management</collection><jtitle>The international journal of tuberculosis and lung disease</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>McDowell, A.</au><au>Pai, M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Treatment as diagnosis and diagnosis as treatment: empirical management of presumptive tuberculosis in India</atitle><jtitle>The international journal of tuberculosis and lung disease</jtitle><addtitle>Int J Tuberc Lung Dis</addtitle><date>2016-04-01</date><risdate>2016</risdate><volume>20</volume><issue>4</issue><spage>536</spage><epage>543</epage><pages>536-543</pages><issn>1027-3719</issn><eissn>1815-7920</eissn><abstract>BACKGROUND: Mismanagement of TB is a concern in the Indian private sector, and empirical management might be a key contributor.OBJECTIVE: To understand factors associated with empirical diagnosis and treatment of presumed TB in India's private sector and examine their effects on
TB care.DESIGN: In this ethnographic study, 110 private practitioners of varying qualification who interacted with TB patients (90 in Mumbai and 20 in Patna) were interviewed, and a subset was observed while providing clinical care. Interviews and observations were analysed for indicators
of empirical diagnosis and treatment.RESULTS: All non-specialist practitioners began antibiotic treatment, especially quinolones, for persistent cough before prescribing a test. Several factors contribute to empirical management. These include a common practice use of medications as diagnostic
tools, a desire to provide rapid symptom relief to patients, a desire to manage illness costs effectively, uncertainty about the presentation of TB, the effects of broad spectrum antibiotics on TB symptomology, and uncertainty about the accuracy of available TB tests.CONCLUSION: Empiricism
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| ispartof | The international journal of tuberculosis and lung disease, 2016-04, Vol.20 (4), p.536-543 |
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| language | eng |
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| source | MEDLINE; PubMed Central; Alma/SFX Local Collection |
| subjects | Disease Management Empiric Management Empirical Research Fluoroquinolones Humans India Mycobacterium Physicians Practice Patterns, Physicians Private Practice Private Sector Tuberculosis Tuberculosis - diagnosis Tuberculosis - therapy |
| title | Treatment as diagnosis and diagnosis as treatment: empirical management of presumptive tuberculosis in India |
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