Abstract
BackgroundThe contrast between the low proportion of tuberculosis (TB) suspects referred from private practitioners in Bali province and the high volume of TB suspects seeking care at private practices suggests problems with TB suspect referral from private practitioners to the public health sector. We aimed to identify key factors associated with the referral of TB suspects by private practitioners.MethodsWe conducted a case-control study conducted in Bali province, Indonesia. The cases were private practitioners who had referred at least one TB suspect to a community health centre between 1 January 2007 and the start of data collection, while the controls were private practitioners who had not referred a single TB suspect in the same time.ResultsThe following factors were independently associated with referral of TB suspects by private practitioners: having received information about the directly observed treatment short-course (DOTS) strategy (OR 2.0; 95% CI 1.1 – 3.8), ever having been visited by a district TB program officer (OR 2.1; 95% CI 1.0 – 4.5), availability of TB suspect referral forms in the practice (OR 2.8; 95% CI 1.5-5.2), and less than 5 km distance between the private practice and the laboratory for smear examination (OR 2.2; 95% CI 1.2-4.0).ConclusionsEducation and exposure of private practitioners to the TB program improves referral of TB suspects from private practitioners to the national TB program. We recommend that the TB program provides all private practitioners with information about the DOTS strategy and TB suspect referral forms, and organizes regular visits to private practitioners.
Highlights
The contrast between the low proportion of tuberculosis (TB) suspects referred from private practitioners in Bali province and the high volume of TB suspects seeking care at private practices suggests problems with TB suspect referral from private practitioners to the public health sector
While many private practitioners serve in both areas, a relatively low proportion of all TB suspects registered in community health centres in Tabanan district had been referred by a private practitioner (1.1%) in 2007, whereas this proportion was relatively high for Karangasem (14.1%)
There was no significant difference in overall knowledge between private practitioners who referred TB suspects and those who did not refer TB suspects to the health centre (OR 1.6; 95% confidence interval (CI) 0.6-4.4)
Summary
The contrast between the low proportion of tuberculosis (TB) suspects referred from private practitioners in Bali province and the high volume of TB suspects seeking care at private practices suggests problems with TB suspect referral from private practitioners to the public health sector. A study involving telephone interviews of 25% of the private practitioners in Jogjakarta province showed that most private practitioners (63%) reported to have seen TB suspects in their private practice. Almost one-third of the interviewed private practitioners never referred a TB suspect to the national TB control program (NTP) for diagnosis and treatment and most of these private practitioners did not offer DOTS treatment [9]. A study in Bali reported three main problems associated with TB care within the private sector: poor TB treatment adherence among patients, limited capacity of public services and poor public-private integration [10]
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