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Management of Pulmonary Tuberculosis by Private Practitioners
in Meerut
Ashish Yadav , S. K. Garg, H. Chopra,
S. K. Bajpai, T. Bano, S. Jain, A. Kumar
Department of Community Medicine
L.L.R.M. Medical College, Meerut
Dr Ashish Yadav 2
Background
• A large segment of the population seek health care from the private sector that includes private medical practitioners.
• Patients seeking health care from these service providers include a significant proportion of tuberculosis patients who are deprived of free TB services provided under RNTCP.
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Dr Ashish Yadav 3
• The private health sector did not have a strong presence when the National Tuberculosis Programme was designed.
• Over the years, however, the private sector has outgrown the public health sector, and today three-quarters of India’s health expenditure takes place in the private sector.
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• About 80% of the qualified medical practitioners in the country are in the private sector and more than half of TB cases seek treatment from private practitioners.
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Objective
• To assess the management modalities of Pulmonary Tuberculosis byprivate practitioners ofMeerut.
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Material and Methods
• A cross sectional study was undertaken covering all the private practitioners registered under IMA, Meerut Branch.
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M.B.B.S.
MD/DNB Medicine
Chest Specialist
Private Practitioners
Dr Ashish Yadav 7
• Among a total of 171 registered practitioners, only 154 practitioners participated in the study giving an overall response rate of 90.1% (154 out of 171).
• They were interviewed by a predesigned and pretested questionnaire about the various diagnostic & treatment modalities of pulmonary TB practiced by them.
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RESULTS
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Qualification of the Private Practitioners( n = 154 )
M.B.B.S. 58 (37.7%)
MD/DNB Medicine
82 (53.3%)
Chest Specialist
14 (9%)
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Experience Number Percentage
< 15 years 66 42.8
15-30 years 38 24.7
>30 years 50 32.5
Total 154 100
Distribution of the private practitioners by their experience
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RNTCP Training of private practitioners
in past 5 years
Yes No 0
10
20
30
40
50
60
70
80
90
67(43.5%)
87(56.5%)
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12
Investigation of first priority for diagnosis
Any RNTCP Training in past 5 years
Total
Yes No
Chest X-ray with Clinical Suspicion 46 (37.7%)
76 (62.3%)
122 (79.2%)
Sputum Examination 16 (72.7%) 6 (27.3%) 22 (14.3%)
Mantoux Test 5 (50%) 5 (50%) 10 (6.5%)
Total 67 (43.5%)87
(56.5%)154
(100%)
First priority investigation used for diagnosis
in relation to RNTCP training
χ2 =9.485 , df = 2 , p < 0.0110/31/2010
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Awareness of categorization among Private Practitioners
Yes No0
20
40
60
80
100
120
107(69.5%)
47(30.5%)
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Practice of Categorization
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38(35.5%)
56(52.3%)
13(12.1%)
Always Sometimes Never
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ATT regimens used by the Private Practitioners
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A total of 154 private practitioners used 53 different treatment regimens to treat pulmonary TB cases.
Dr Ashish Yadav 16
ATT administration in accordancewith RNTCP
Yes No0
10
20
30
40
50
60
70
80
38(25.2%)
116(74.8%)
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Drug combinations used by the private practitioners for Intensive Phase
HR
HRE
HRES
HRZ
HRZE
HRZEL
HRZES
HRZS
0 20 40 60 80 100 120
4 (2.6%)
10 (6.5%)
1 (0.6%)
16 (10.4%)
104 (67.5%)4 (2.6%)
14 (9.1%)
1 (0.6%)
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Use of Sputum Smear Examination as a criteria to stop the treatment
Yes No0
20
40
60
80
100
120
140
38(24.6%)
116(75.4%)
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19
Parameters used as a criteria to stop treatment of tuberculosis
01020304050607080
6(3.9%)
8(5.2%)
24(15.6%)
75(48.7%)
14(9.1%)
27(17.5%)
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Dr Ashish Yadav 20
Conclusion
• Sputum examination is being neglected for diagnosis & as a criterion for stopping treatment.
• There is marked reliance on X-ray among private practitioners for management of Pulmonary TB.
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• There is an urgent need tostrengthen the RNTCPtraining of the private practitioners and sensitizethem for their reorientationtowards standard managementof tuberculosis.
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