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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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• 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
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• 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.
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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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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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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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