Survey of the previous investigation and treatment by private practitioners of patients with pulmonary tuberculosis attending Government chest clinics in Hong Kong

Abstract

A questionnaire was applied to 159 consecutive patients with smear-positive and 187 with smear-negative pulmonary tuberculosis attending the 8 full-time Government chest clinics in Hong Kong for the first time for their current illness, who had already attended a private practitioner at a private general practice, a private clinic, or an independent hospital, outside the Government or Government-subsidised Service. The aim was to obtain details of management by private practitioners, and in particular of the antituberculosis chemotherapy prescribed.The great majority (86%) of the patients had originally attended a private practitioner because of symptoms. Only 18% had had their sputum examined, although 76% had had a chest radiograph; 65% of the smear-positive and 71% of the smear-negative patients had been told that they had, or might have, tuberculosis. For 40% there was an interval of more than a month between their first attendance at a private practitioner and at a Government chest clinic. Only 11% of the patients were referred without delay to a Government chest clinic, and another 21% once tuberculosis had been diagnosed or suspected.The patients were asked to name the drugs they had been prescribed, to produce samples, or to identify them from a perspex board containing samples of all 49 antituberculosis tablets and capsules known to be available in Hong Kong at the time. In the event, only 11% of the patients could name some or all of their medicaments and only 7% could produce samples, although a further 76% were able to describe them with or without the aid of the perspex board. In all, 19% of the patients were definitely or probably prescribed an antituberculosis regimen, although this was not always an adequate regimen.The findings suggest that there is considerable scope for active case-finding aimed at encouraging patients who are likely to have tuberculosis to attend a Government chest clinic.