Patient pathways of tuberculosis care-seeking and treatment
An individual-level analysis of National Health Insurance data in Taiwan
Bibliographic Data
| ID | 21880911 |
|---|---|
| Authors | Chu-Chang Ku (University of Sheffield, corresponding author), Chu Chang Ku (0000-0002-4719-117X, School of Health and Related Research, The University of Sheffield, Sheffield, UK), Chien-Chou Chen (Soochow University), Chien‐Chou Chen (0000-0001-5167-2630, Soochow University), Simon Dixon (0000-0002-6098-481X, University of Sheffield), Hsien-Ho Lin (0000-0002-7481-6016, National Taiwan University), Hsien Ho Lin (National Taiwan University), Peter J Dodd (0000-0001-5825-9347, University of Sheffield) |
| Year | 2020 |
| Volume | 5 |
| Issue | 6 |
| Pages | e002187 |
| Publication date | 2020-06-01 |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | BMJ Global Health (JOURNAL) |
| Journal identifiers | ISSN: 2059-7908 • E-ISSN: 2059-7908 |
| Publisher | BMJ (PUBLISHER • GB) |
| DOI | 10.1136/bmjgh-2019-002187 |
| PMID | 32565426 |
| OpenAlex | W3036525679 |
| Language | EN |
| Citations received | 5 |
| References cited | 23 |
INTRODUCTION: Patients with tuberculosis (TB) often experience difficulties in accessing diagnosis and treatment. Patient pathway analysis identifies mismatches between TB patient care-seeking patterns and service coverage, but to date, studies have only employed cross-sectional aggregate data. METHODS: We developed an algorithmic approach to analyse and interpret patient-level routine data on healthcare use and to construct patients' pathways from initial care-seeking to treatment outcome. We applied this to patients with TB in a simple random sample of one million patients' records in the Taiwan National Health Insurance database. We analysed heterogeneity in pathway patterns, delays, service coverage and patient flows between different health system levels. RESULTS: We constructed 7255 pathways for 6258 patients. Patients most commonly initially sought care at the primary clinic level, where the capacity for diagnosing TB patients was 12%, before eventually initiating treatment at higher levels. Patient pathways are extremely heterogeneous prior to diagnosis, with the 10% most complex pathways accounting for 48% of all clinical encounters, and 55% of those pathways yet to initiate treatment after a year. Extended consideration of alternative diagnoses was more common for patients aged 65 years or older and for patients with chronic lung disease. CONCLUSION: Our study demonstrates that longitudinal analysis of routine individual-level healthcare data can be used to generate a detailed picture of TB care-seeking pathways. This allows an understanding of several temporal aspects of care pathways, including lead times to care and the variability in patient pathways
Care pathway · Clinical pathway · Disease · Family medicine · Health care · Medical diagnosis · Pathology · Tuberculosis · Chronic Disease Management Strategies · Clinical practice guidelines implementation · Medicine · Nursing · Tuberculosis Research and Epidemiology
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| Citations per year | 1.67 |
|---|---|
| Citation span | 2023 - 2025 (3) |
| Highly cited | No |