Strengthening tuberculosis patient referral mechanisms among health facilities in Punjab, Pakistan

To describe approaches to strengthen existing tuberculosis (TB) patient referral mechanisms in Punjab, Pakistan.

A descriptive intervention study was conducted through medical chart review. All new smearpositive pulmonary TB patients diagnosed at Gulab Devi Hospital, Lahore, who were referred to any of the primary health care (PHC) units in Punjab Province, were enrolled from January to September 2009. TB coordinators at the referral unit maintained an electronic TB referral/transfer register (e-TRTR) as their key referral monitoring tool.

Of 444 new smear-positive pulmonary TB patients enrolled in the study, 181 (41%) confirmed that they had arrived and were registered at the receiving PHC units, and another 17 (4%) had gone to other health facilities. Of the 181 access-confirmed patients at the receiving PHC units, seven were confirmed by postal mail, 49 by district TB coordinators, and the remaining 125 only through direct phone calls made by Provincial TB Programme staff.

The present study indicates that utilisation of a referral register (e-TRTR), appointment of a responsible person for patient referral at the hospital, close monitoring of the referral by telephone and communication with responsible TB coordinators bring about a considerable improvement in the TB patient referral mechanism.