|
|
CHAPTER II - HEALTH SERVICES |
|
|
|
|
157 |
AU |
: |
Uplekar MW, Juvekar SK & Shepard DS |
TI |
: |
Treatment of tuberculosis by private general practitioners
in India |
SO |
: |
TUBERCLE 1991, 72, 284-290 |
DT |
: |
Per |
AB |
: |
Early detection and optimal treatment constitute
the most important measures in the control of TB. A study of doctors
practicing in a large low income settlement of Bombay was carried
out to find out the prescribing pattern for treatment of TB. The
doctors selected by simple random were a mixture of those qualified
in western medicine (allopaths) and those qualified in indigenous
systems such as Ayurveda, Homeopathy and Unani (non-allopaths).
From the list of total 287 doctors, 143 were selected. The sample
included 79 allopaths and 64 non-allopaths.
All the doctors were requested to write a prescription
for a previously untreated adult case of sputum positive pulmonary
TB indicating drug used, dosages and duration. The slips were collected
by the Investigator on the spot and later analysed by EPI-INFO software.
Of the 143 doctors, 31 (22%) refused participation in the study.
The final analysis included 102 doctors (48 allopaths and 54 non-allopaths).
Hundred doctors using two or more of the five anti-TB drugs (S,
H, R, Z & E) prescribed 80 different regimens non-confirmed
with standard recommended regimen except for two doctors who wrote
indigenous drugs. None of them employed thioacetazone as the anti-TB
drug or recommended intermittent regimen.
This study highlights that irrespective of their
background and training, most of the doctors use modern chemotherapeutic
agents in the treatment of TB. Most of the regimens were inappropriate,
expensive and of long duration of 12-24 months.
This inefficient use of scarce resources may be
avoided through Continuing Medical Education of private doctors
by experts. Effective media and other possible modes of communication
could be used to educate lay people about the disease, the importance
of regularity of treatment. Ways need to be considered to make private
doctors participate in effective implementation of programme, for
which their curative functions could contribute significantly to
control the disease.
|
KEY WORDS: PRIVATE DOCTORS; GENERAL PRACTITIONER; DOCTORS
AWARENESS; INDIA |
158 |
AU |
: |
Uplekar MW & Sheela Rangan |
TI |
: |
Private doctors and tuberculosis control in India |
SO |
: |
TUBERCLE AND LUNG DIS 1993, 74, 332-337 |
DT |
: |
Per |
AB |
: |
Over three quarters of the 8 million registered
doctors in India are engaged in private medical practice. In urban
and rural areas alike people prefer private doctors to public health
services for their health care needs. A majority of patients and
those with suspected TB also report first to private doctors. A
study on private doctors and TB control in India was
conducted in Dharavi a shanty settlement of Bombay metropolis to
assess their knowledge and practice as regards the diagnosis and
treatment of pulmonary TB, their awareness of the NTP and their
impression of public health services. A population of 200,000 people
was randomly selected. Among a total of 207 private allopathic and
non-allopathic doctors serving the population, 143 were interviewed
on a semistructured interview schedule on various aspects of TB,
its diagnosis and treatment; 31 doctors refused and 10 could not
give time. The completed schedules were obtained from 102 (70%)
of doctors (48 allopaths and 54 non-allopaths). All of them stated
to have come across TB patients in their practice and 25 stated
correctly that it is not a notifiable disease. All the doctors were
aware of the symptoms of early manifestation of TB, about 20% replied
that they would first investigate the patient before starting treatment,
60% would give antibiotic, 10% with cough mixture and 10% treat
for eosinophilia. In response to confirm clinical diagnosis of TB
all the doctors would subject the patients to X-ray, ESR & CBC,
and 38% of them said they relied on sputum examination. All except
2 doctors employed 80 types of regimens containing SCC drugs, most
of them were expensive, inappropriate and non-standard. Cost of
drug treatment ranged from Rs.1500/- to Rs.5000/-, cost of diagnosis
from Rs.50/- to Rs.200/-. Compliance by patients was reported to
be in the range of 25% to 50%. The private doctors perceptions
for treatment default by TB patients were illiteracy, lack of funds,
carelessness, relief of symptoms and ignorance.
The nearest government facility providing free
diagnosis and treatment to TB patients with all the facilities was
a Municipal Clinic with an OPA of 35 per day. About 500 TB patients
were under treatment at that point of time. All anti-TB drugs were
available in the clinic. A large majority of the private doctors
referred those patients who could not afford treatment, to this
clinic. Their opinion about public health service was as follows:
half of them found unsatisfactory, 40% average, 10% would never
refer their patients due to bad treatment. About 70% of private
doctors were aware about NTP but could not elaborate on the activities
of NTP. About updating their knowledge on TB, 65% mentioned medical
representatives of drug companies, 25% through books, 5% through
CMEs and 5% did not reply.
Although private practitioners are the first points
of contact by the patients, few attempts have been made to involve
them in the important national disease control programmes. As a
result, although they treat the TB patients in their clinics, but
poorly. The importance of notification is well known, yet none of
the private doctors ever reported a case of TB. As a result, private
doctors seem to be alienated from national efforts towards control
of TB, there being no well-defined role for them in the NTP. It
is evident from this study that private doctors cannot be wished
away, as the people opt for their services, but at the same time
they must not be granted total freedom to act as they see fit without
caring for the consequences. There is a need for better communication
between the private doctors and those implementing disease control
programmes so as to enable them to follow appropriate clinical and
public health practices.
|
KEY WORDS: PRIVATE DOCTORS; GENERAL PRACTITIONER; DOCTORS
AWARENESS; INDIA. |
159 |
AU |
: |
Uplekar MW, Juvekar SK, Parande SD, Dalal DB, Khanvilkar
SS, & Sheela Rangan |
TI |
: |
Tuberculosis management in private practice and its
implications |
SO |
: |
INDIAN J TB 1996, 43, 19-22 |
DT |
: |
Per |
AB |
: |
This study of 81 rural and 96 urban private medical
practitioners, which included 67 allopaths and 110 nonallopaths,
was conducted to understand how patients of lung TB are diagnosed
and treated in their clinics as well as their interactions with
and perceptions regarding the public health services available for
TB control. A majority of private doctors gave little importance
to sputum examination and considered X-ray of the chest as the single
most important diagnostic test for lung TB. They were neither aware
of nor employed inexpensive standard regimens for treating their
patients. While all private doctors used SCC in the treatment of
lung TB, few regimens used by them conformed to the ones recommended
under the NTP. Private doctors were aware of but sceptical about
TB treatment available at public health facilities.
|
KEY WORDS: PRIVATE PRACTITIONER; INDIA |
160 |
AU |
: |
Uplekar MW |
TI |
: |
The private medical sector and tuberculosis control
in India |
SO |
: |
Proceedings of International CME on TB, 27th &
28th Sep. 1996, p.159-160 |
DT |
: |
CP |
AB |
: |
This paper presents the findings of some of the
first studies on the private sector in TB control in India, undertaken
by the Foundation for Research in Community Health, in the rural
and urban parts of Maharashtra. Two studies examined the management
practices of private medical practitioners. One prospective study
documented the treatment behaviour of TB patients under care of
private medical practitioners and the third one evaluated two city-based
TB projects undertaken by groups of private medical practitioners.
|
KEY WORDS: PRIVATE SECTOR; INDIA. |
162 |
AU |
: |
Uplekar MW, Juvekar S, Morankar S, Sheela Rangan &
Nunn P |
TI |
: |
Tuberculosis patients and practitioners in private
clinics in India |
SO |
: |
INT J TB & LUNG DIS 1998, 2, 324-29 |
DT |
: |
Per |
AB |
: |
This study is conducted in Rural and urban areas
of Maharashtra, a large state in Western India. to understand TB
management practices among private medical practitioners (PPs) and
the treatment behaviour of the patients they manage.
Prospective study of help-seeking patterns and
treatment behaviour among 173 pulmonary TB patients diagnosed in
private clinics, and the TB management practices of 122 PPs treating
these patients.
The first source of help for 86% of patients was
a PP. The diagnostic and treatment practices of PPs were inadequate;
15% did not consider sputum examination to be necessary, and 79
different treatment regimens were prescribed by 105 reporting PPs.
Sixty seven percent of the patients diagnosed in private clinics
remained with the private sector, and the rest shifted to public
health services within six months of treatment. The treatment adherence
rate among the patients in private clinics was 59%. There were discrepancies
between the reported management practices of the PPs and what their
patients actually followed.
The study identifies and highlights the need to
educate PPs and their TB patients, and indicates ways in which PPs
could be meaningfully involved in efforts to revitalize the NTCP.
|
KEY WORDS: PRIVATE PRACTITIONER; MANAGEMENT PRACTICES;
INDIA. |
|
|