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Whole-course quality of tuberculosis (TB) care in rural China: a retrospective study based on chart abstraction

Mingyue Li^1,2,3, Xiaotian Zhang^2,4, Haozhe Cheng²

¹Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China.

|May 31, 2024

Abstract

Objectives:

The aim of this study was to assess the quality of tuberculosis (TB) care for the whole course and assess factors that affect completing treatment.

Design:

This is an observational retrospective study using chart abstraction for the whole course of TB care conducted at two underserved provinces in China.

Setting:

The study was conducted from June 2021 to July 2021. All medical records (outpatient and inpatient) for the whole course (6-8 months) of patients with TB newly registered from July 2020 to December 2020 were reviewed and abstracted using predetermined checklists.

Participants:

A total of 268 outpatient medical records and 126 inpatient records were included.

Primary And Secondary Outcome Measures:

The primary outcome included diagnostic quality, treatment quality and management quality. The secondary outcome was completing treatment.

Results:

For diagnostic quality, 94.2% of the diagnosis were based on adequate evidence. For treatment quality, 240 (91.6%) outpatients and 100 (85.5%) inpatients took the standard chemotherapy regimens. 234 (87.3%) patients completed treatment. 85.1% of the inpatients prescribed with second-line drugs were inappropriate. For management quality, 128 (47.9%) patients received midterm assessments, but only 47 (19.7%) received sufficient services for the whole course. Patients with TB symptoms were 1.8 times more likely to complete treatment (p=0.011).

Conclusion:

Patients with TB received high-quality diagnosis and treatment services, but low-quality whole-course management. Integration of medical and public health services should be strengthened to improve whole-course quality.

Keywords:

health policy primary health care tuberculosis

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