Prescribing practices for presumptive TB among private general practitioners in South Africa

A cross-sectional, standardised patient study

Datos Bibliográficos

ID21880433
AutoresAngela Salomon (0000-0003-1856-953X, Queen's University), Jody Boffa (0000-0002-8183-6461, Stellenbosch University), Sizulu Moyo (0000-0002-5296-3242, Human Sciences Research Council), Jeremiah Chikovore (0000-0002-4910-6952, Human Sciences Research Council), Giorgia Sulis (0000-0001-6641-0094, McGill University Health Centre), Benjamin Daniels (0000-0001-8617-6055, Georgetown University), Alistair Kwan (0000-0003-4889-9433, University of California System), Tsatsawani Mkhombo, Sarah Wu (0000-0003-4460-5311, Columbia University), Madhukar Pai (0000-0003-3667-4536, McGill University Health Centre), Amrita Daftary (0000-0003-2275-3540, York University, autor de correspondencia)
Año2022
Volumen7
Número1
Páginase007456
Fecha de publicación2022-01-01
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaBMJ Global Health (JOURNAL)
Identificadores de la revistaISSN: 2059-7908 • E-ISSN: 2059-7908
EditorialBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2021-007456
PMID35042710
OpenAlexW4205714483
IdiomaEN
Citas recibidas7
Referencias citadas42

INTRODUCTION: Medicine prescribing practices are integral to quality of care for leading infectious diseases such as tuberculosis (TB). We describe prescribing practices in South Africa's private health sector, where an estimated third of people with TB symptoms first seek care. METHODS: Sixteen standardised patients (SPs) presented one of three cases during unannounced visits to private general practitioners (GPs) in Durban and Cape Town: TB symptoms, HIV-positive; TB symptoms, a positive molecular test for TB, HIV-negative; and TB symptoms, history of incomplete TB treatment, HIV-positive. Prescribing practices were recorded in standardised exit interviews and analysed based on their potential to contribute to negative outcomes, including increased healthcare expenditures, antibiotic overuse or misuse, and TB diagnostic delay. Factors associated with antibiotic use were assessed using Poisson regression with a robust variance estimator. RESULTS: Between August 2018 and July 2019, 511 SP visits were completed with 212 GPs. In 88.5% (95% CI 85.2% to 91.1%) of visits, at least one medicine (median 3) was dispensed or prescribed and most (93%) were directly dispensed. Antibiotics, which can contribute to TB diagnostic delay, were the most common medicine (76.5%, 95% CI 71.7% to 80.7% of all visits). A majority (86.1%, 95% CI 82.9% to 88.5%) belonged to the WHO Access group; fluoroquinolones made up 8.8% (95% CI 6.3% to 12.3%). Factors associated with antibiotic use included if the SP was asked to follow-up if symptoms persisted (RR 1.14, 95% CI 1.04 to 1.25) and if the SP presented as HIV-positive (RR 1.11, 95% CI 1.01 to 1.23). An injection was offered in 31.9% (95% CI 27.0% to 37.2%) of visits; 92% were unexplained. Most (61.8%, 95% CI 60.2% to 63.3%) medicines were not listed on the South African Primary Healthcare Essential Medicines List. CONCLUSION: Prescribing practices among private GPs for persons presenting with TB-like symptoms in South Africa raise concern about inappropriate antimicrobial use, private healthcare costs and TB diagnostic delay

Cross-sectional study · Environmental health · Family medicine · Pathology · Public health · Antibiotic Use and Resistance · Medicine · Nursing · Pharmaceutical Practices and Patient Outcomes · Tuberculosis Research and Epidemiology · Pediatrics