Initial Treatment Seeking Research Articles

A comparison of patient treatment pathways among multidrug-resistant and drug-sensitive TB cases in Delhi, India: A cross-sectional study

BackgroundThe delay in the diagnosis and treatment initiation of patients with MDR-TB worsens individual prognosis and increases the risk of disease transmission in the community. These delays have been attributed to delay in treatment-seeking by the patient and shifting to multiple healthcare facilities before being tested and diagnosed through India's National Tuberculosis Elimination Program (NTEP). Objectiveto identify treatment pathways in patients with MDR-TB from the time of onset of symptoms and treatment seeking until diagnosis at a PMDT site and subsequent treatment initiation. We also compared these characteristics with those of patients with DS-TB. MethodsWe recruited a total of 168 patients with MDR-TB and DS-TB each, in Delhi. Data were analyzed using IBM SPSS Version 25. ResultsThe mean (SD) patient delay for initial treatment-seeking was 20.9 (15.9) days in patients with MDR-TB, and 16.1 (17.1) days in patients with DS-TB (p < 0.001). The median time from visit to the first healthcare facility (HCF) until confirmation of MDR-TB diagnosis was 78.5 days, and until treatment initiation was 102.5 days. Among patients with DS-TB, the time interval from a visit to the first HCF until the initiation of ATT-DOTS was 61.5 days.. Patients diagnosed with DS-TB, whose first source of treatment was a private facility (n = 49), reported a significant delay in the initiation of ATT-DOTS (p < 0.001). ConclusionsDespite the introduction of universal drug sensitivity testing in individuals having presumptive MDR-TB, a significant delay in the diagnosis and initiation of effective MDR-TB treatment persists as a major public health challenge in India.

The effects of tiered healthcare service delivery on the cost control and quality improvement in rural China: an interrupted time series analysis

Introduction: Worldwide, many countries have established their own gatekeeper system. Tertiary hospitals in China have experienced explosive growth both in the quantity and quality since 2009. However, the healthcare delivery system in China is fragmented for its weak coordination between different faculties. And it was not well prepared for the tremendous and complex needs, especially the grassroots healthcare faculties whittled by the tertiary hospitals. Moreover, it has caused the increasing of total health expenditure and occurrence of catastrophic health expenditure.Policy context and objective: To deal the unreasonable resources distribution among the tertiary-grassroots faculties and urban-rural areas, and establish a high-value healthcare delivery system. In January 2013, the tiered healthcare service delivery was first implemented among Qinghai and Hubei province. Given emerging problems might influence the current policy analysis from different perspective may achieve contrasting results, it is necessary to evaluate the secular effects of the previous pilots and synthesis its experience for the following programs with the similar contextual settings.Targeted population: The New Rural Cooperative Medical System enrollee in the Dangyang.Highlights: A quasi-natural experiment was designed in Dangyang, Hubei province. And the policy were piloted in October 2014, policies related to this reform and claim data from January 2011 to December 2015 were collected from the New Cooperative Medical Scheme (NCMS) enrollees. First, the patients are motivated to take the grassroots faculties for the initial treatment-seeking, with different reimbursement ratio settings varied with the delivery system levels. Second, all the county-level hospitals have to establish the integrated delivery system with more than township faculties. Third, all community healthcare centers should carry out the family doctors system and the grassroots faculties in rural areas should be equipped with a physician good at the Traditional Chinese Medicine.The outcomes indicated the changes in cost and patients flow were included to evaluate its effects and calculated monthly based on the claim data. Policy analysis and interrupted time series analysis model were designed to estimate the before-after changes in the indicators with Stata version 13.0. All the cost data was adjusted according the 2016 China Health Statistics Yearbook.The actual reimburstment ratio and the proportion of total medical expenses in township hospitals increased significantly in the first month of the implementation of the tired medical system policies, and has reversed the orginal downward trend. Meanwhile, the upward trend and level of out-of-pocket has significantly declined. However, the level and trend of proportion of health expenditure and patient visits in health care facilities outside Dangyang did not decreased significantly, so does the average length of stay and average total cost. The proportion of total patient visits in township hospitals increased at first, but not reversed significantly in the long term.Conclusions: Although this policy has not achieved all its expected outcomes temporarily, it has reduce the out-of-pocket cost for patients and improve the effectiveness of the grassroots facilities. Further studies should focus on the more comprehensive evaluation of health system and an appropriate control group should be found.

Parental causal explanations and treatment seeking in attention deficit hyperactivity disorder: Perspectives from a developing nation based on process theory

IntroductionCultural factors have an important role in causal model of symptoms, threshold for treatment seeking and acceptability of professional help in ADHD.Objectives and aimsTo explore causal explanations and treatment seeking amongst parents of children with ADHD and understand these in context of a largely collectivistic culture as in India.MethodsIn-depth semi-structured interviews were conducted with 27 consenting parents; data interpreted using process theory.ResultsInitial reaction to psychiatric referral revealed themes of disbelief/surprise, feeling confused/offended and lag of 6–36 months to consultation. Parents most commonly attributed causality to psychosocial reasons (lack of motivation/volitional, inadequate disciplining), while few gave one or more biomedical explanations (epilepsy, brain damage, low birth weight, nutritional deficiency, maternal ill health, low intelligence) alone or with a psychosocial reason. Despite the initial reaction, all but 1 parent was relieved with medical explanation, accepted diagnosis, and perceived need for treatment. Most parents were willing to start/continue medication if doctor suggested so as “he/she would know the best”. All parents expressed that counseling was needed.ConclusionsInitial reactions and delay in treatment seeking is understood in light of cultural attitudes towards mental illnesses and psychiatric consultation in developing nations. More importantly, despite initial reluctance, most parents accepted biomedical explanation and treatment. The doctor patient relationship modeled on a guru-chela relation of complete trust in authority can explain this process change. We conclude that cultural attitudes not only influence causal models and initial treatment seeking, but also modify process of help seeking.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Initial treatment seeking from professional health care providers for eating disorders: A review and synthesis of potential barriers to and facilitators of "first contact".

The objective of this study is to provide a comprehensive review of empirical research exploring barriers to and facilitators of initial treatment seeking ("first contact") from professional health care providers by adults and young adults with eating disorders (EDs). A search of databases PsycINFO and MEDLINE using the terms "treatment" and "eating disorder*" yielded 9,468 peer-reviewed articles published from January 1945 to June 2016. Screening identified 31 articles meeting the following criteria: (1) participants were 16 or older and presented with a self-reported or clinically diagnosed ED; (2) studies focused on (a) initial treatment seeking (b) for an ED (c) from professional health care providers; (3) articles were empirical, and (4) peer reviewed. Quantitative studies revealed few consistent correlates of treatment seeking, perhaps because most variables were examined in only one or two investigations. Variables with some degree of predictive utility (i.e., produced significant results in multiple studies) were age (older), ethnicity (nonethnic minority), ED type (anorexia, purging BN), specific ED-related behaviors (i.e., purging), and time spent on a treatment waitlist following referral (less). Although BMI was one of the most investigated variables, it did not predict treatment seeking. Qualitative studies revealed the following perceived barriers: (1) personal feelings of shame/fear, (2) ED-related beliefs/perceptions, (3) lack of access/availability, and (4) aspects of the treatment process. Perceived facilitators included (1) health-related concerns, (2) emotional distress, and (3) social support. Implications for clinical practice and areas for further research are discussed. Results highlight the need for shared definitions and methodologies across studies of treatment seeking.

Overcoming Barriers to Sustained Engagement in Mental Health Care: Perspectives of Rural Veterans and Providers

To better understand the attitudes, beliefs, and values that influence use of mental health care among rural veterans. In-depth, semistructured interviews were conducted with 25 rural veterans and 11 rural mental health care providers in 4 states. Experienced qualitative interviewers asked participants about the attitudinal factors they thought most influenced rural veterans' decisions to seek and sustain mental health care. Verbatim transcriptions were analyzed using content analysis and constant comparison. Rural veterans and their mental health care providers reported the same major attitudinal barriers to veterans' mental health treatment-seeking. Pre-eminent among those barriers was the importance rural veterans place on independence and self-reliance. The centrality of self-reliance was attributed variously to rural, military, religious, and/or gender-based belief systems. Stoicism, the stigma associated with mental illness and health care, and a lack of trust in the VA as a caring organization were also frequently mentioned. Perceived need for care and the support of other veterans were critical to overcoming attitudinal barriers to initial treatment-seeking, whereas critical facilitators of ongoing service use included "warm handoffs" from medical to mental health care providers, perceived respect and caring from providers, as well as provider accessibility and continuity. Attitudes and values, like self-reliance, commonly associated with rural culture may play an important role in underutilization of needed mental health services. System support for peer and provider behaviors that generate trust and demonstrate caring may help overcome attitudinal barriers to treatment-seeking and sustained engagement in mental health care among rural veterans.

Effects of HIV prevention messages on treatment-seeking and adherence for HIV-infected children in Maputo, Mozambique: A qualitative study

As antiretroviral treatment (ART) becomes more readily available to children in sub-Saharan Africa (SSA), it is important that the experiences of children and their caretakers be carefully examined from more than just a logistical perspective. This paper is based upon an original exploratory and qualitative study that focused on ART in Mozambique. Through in-depth semi-structured interviews, the study examined the experiences of 26 caretakers—primarily mothers—of pediatric patients aged 3–12 receiving ART through the Pediatric Day Hospital of the Maputo Central Hospital (Mozambique) as well as those of their clinicians (7 physicians and 2 dedicated nurses).The interviews focused on the effect of standard HIV prevention communications on pediatric treatment-seeking and ART adherence via several mediating factors such as: 1) Caretakers' sources of HIV information and their perceived reliability; 2) Levels of trust and communication between providers and patients/caretakers related to the completeness of discussions dealing with HIV risk factors and modes of transmission (particularly for the 19% of mothers interviewed who were uninfected themselves) and; 3) The potential propagation of shame and fear through HIV prevention messages which may contribute to sub-optimal adherence (marked, for example, by fear of involuntary disclosure to others in the child's household).The results indicate that all three of these mediating factors deserve further attention as caretakers did, indeed, report adverse effects on initial treatment-seeking and adherence for the children in their care broadly linked with these factors. As patients and their caretakers often must progress through several counseling sessions before or during commencement of ART, there is ample opportunity for these interpersonal and psychosocial factors to be addressed without the need for further financial or human resource allocations.

Randomized trial of clozapine vs. risperidone in treatment-naïve first-episode schizophrenia: Results after one year

In first-episode patients with psychosis, clozapine may be potentially valuable as an initial treatment seeking to limit early on clinical and cognitive deterioration. Nevertheless, until recently its restricted use has limited the study of this possibility. Our research group is developing a non-commercial, multicentric and open label study on the differential efficacy between clozapine and risperidone in first-episode schizophrenia. In this paper, we present the results related to clinical variables after a one-year follow-up. So far, we have recruited 30 patients diagnosed with schizophrenia or schizophreniform disorder with illness duration of less than two years. The patients had not received any previous treatment and they were randomized to treatment with clozapine or risperidone. Our results indicate that on average, patients on clozapine adhered to their original treatment for a longer time period than patients on risperidone. By last observation carried forward (LOCF) analysis, patients on clozapine and risperidone displayed similar clinical improvements, although marginally greater improvements in positive and total symptoms scores were found in the clozapine group. At the 12-month point we observed a marginal improvement in negative symptom scores in patients on clozapine. Subjective secondary effects, as measured with the Udvalg for KliniskeUndersøgelser (UKU) scale, correlated negatively with negative symptoms at follow-up. Our data, although preliminary, suggest that clozapine may have a slightly superior efficacy in the initial year of treatment of first-episode treatment-naïve patients with schizophrenia, and this can be explained for the most part by greater adherence to this treatment.

Social functioning in urban, predominantly African American, socially disadvantaged patients with first-episode nonaffective psychosis

Background Social functioning impairments develop and accumulate even prior to initial treatment-seeking for first-episode psychosis. This study, the first to examine social functioning in low-income, urban, predominantly African American first-episode patients: (1) assesses the internal consistency of Social Functioning Scale (SFS) subscales in this relatively unique sample; (2) identifies demographic and clinical variables that may be predictive of poor social functioning in this particular population; and (3) assesses changes in SFS scores in a subsample re-assessed six months after initial hospitalization. Methods 109 participants (age, 23.1 ± 4.7 years; 76.1% male; 89.9% African American) hospitalized for a first episode of nonaffective psychosis in an urban, public-sector setting were administered the SFS along with other clinical research instruments. 34 (31.2%) returned for a follow-up clinical research assessment six months after baseline assessment. Associations between the variables of interest were analyzed utilizing independent samples Student's t-tests and Pearson correlations. Results Associations were observed between social functioning domains and negative symptoms ( r = −.21–−.32, p < .05), depressive symptoms ( r = −.20–−.23, p < .05), and general psychopathology symptoms ( r = −.23–−.24, p < .05). No significant differences were found in SFS subscale scores between baseline and six-month follow-up. Conclusions Deficits in social functioning are meaningfully related to several domains of symptoms, and such deficits may be relatively stable in the early course of psychotic disorders. Such findings may inform development of psychosocial interventions targeting social functioning in first-episode patients.

Specialized home treatment versus hospital‐based outpatient treatment for first‐episode psychosis: a randomized clinical trial

This pilot study compared the effectiveness of specialized care that was home based versus hospital based for individuals experiencing their first psychotic episode. A randomized controlled trial design was used. A total of 29 subjects were interviewed at baseline, 3 and 9 months. Repeated measures analysis of variance was employed to test for statistically significant changes over time within and between groups with regard to community psychosocial functioning and symptom severity. Our findings indicate that subjects in both the home-based and hospital-based programmes significantly improved with regard to symptoms and community functioning over time. However, the rates of change over time were not significantly different between the two programmes. There was a statistically significant difference between programmes with regard to the proportion of subjects with less than two visits (i.e. either did not attend their first assessment or attended follow-up visits after their assessment). This was a modest pilot study and the sample was too small to allow definitive conclusions to be drawn. However, the results raise questions about differences in initial treatment engagement. They suggest the need for additional research focusing on interventions that promote initial treatment seeking.

Treatment Seeking for a Chronic Disorder: How Families in Coastal Kenya Make Epilepsy Treatment Decisions

A person-centered case-study approach was used to account for treatment choices made by families of children with epilepsy seizure disorders in Kilifi, Kenya. Observations of individual families and treatment providers suggest that the local cultural system of illness classification and the process of assessing treatment results are fundamental influences on family decisions to seek treatment for childhood seizure disorders. The findings also indicate that the dominance of these two factors shifts throughout the illness experience. Family classification of seizures and cultural perceptions of their causation are primary in initial treatment seeking, while the perception of results of the last treatment sought dominates subsequent treatment decisions. External factors, including pressure from individuals outside the family, and financial and time resources, are described as secondary constraining factors in the decision making process. A model is presented to summarize the decision making process. The model accounts for treatment seeking in families of children with seizure disorders in coastal Kenya but may also help explain how families manage other chronic conditions.

COGNITION AND THE BODY: SOMATIC ATTRIBUTIONS IN IRRITABLE BOWEL SYNDROME

How do somatic causal attributions for symptoms relate to treatment seeking behaviour in Irritable Bowel Syndrome (IBS)? How might a tendency to make somatic attributions influence an individual's cognitive representation of their illness once a diagnosis of IBS is established? In Study 1 attributions about symptoms were investigated in treatment-seekers and non treatment-seekers with IBS. Treatment-seekers had an increased tendency to make somatic attributions for both gastrointestinal symptoms and physiological symptoms characteristic of anxiety and depression, although they did not differ from non treatment-seekers in the severity of these symptoms or in their reports of psychological distress. Treatment-seekers also perceived themselves to be significantly less resistant to illness and to be significantly more likely to have poor health in the future than non treatment-seekers. In Study 2, 20 treatment seekers with chronic symptoms of IBS completed measures of mood and of the degree to which they viewed a range of symptoms as a part of their IBS. Physiological symptoms of anxiety and depression were seen as a part of IBS by a considerable proportion of the sample. Higher levels of depression were associated with an increased tendency to see physiological symptoms of anxiety and depression and even symptoms of colds as “a part of” IBS. It is concluded that a somatic attributional style may contribute both to initial treatment seeking for symptoms of IBS and the subsequent maintenance and exacerbation of the disorder once a diagnosis is established.

Health-seeking strategies and sexual health among female sex workers in urban India: Implications for research and service provision

This paper presents and discusses selected findings from a study of health-seeking strategies in relation to sexual health among a group of female sex workers in Calcutta, India. Background information on sex work and sexually transmitted disease in Calcutta is followed by the presentation of findings pertaining to women's understandings of (sexual) health, treatment-seeking and service utilisation. In the urban context where health services are readily available, patterns of initial treatment-seeking are shown to be generally (biomedically) appropriate, but subsequent “non-compliant” therapeutic practices give cause for concern. Conventional approaches to the study of “health-seeking behaviour” are reviewed in the light of these findings and questions raised about the appropriateness of approaches that focus on initial choice of treatment type and/or assume processes of health-seeking to be determined primarily by cultural “beliefs” about illness. Inherent biomedical and culturalist biases in the orientation of such research are shown to produce an analytic neglect of the dual influences of material life conditions and people's perceptions of health, rather than illness, upon health-related strategies. Recommendations are made for operational research and policy formulation on the provision of effective sexual health services, and implications are drawn for the scope of interventions and applied research directed at improving sexual health.