Measuring Quality Gaps in TB Screening in South Africa Using Standardised Patient Analysis

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Christian, Carmen SStellenbosch University,University of the Western Cape (author)

Measuring Quality Gaps in TB Screening in South Africa Using Standardised Patient Analysis

Article/chapterEnglish2018

Publisher, publication year, extent ...

2018-04-12
MDPI AG,2018
10 s.
electronicrdacarrier

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LIBRIS-ID:oai:lup.lub.lu.se:f13d3416-ce16-40fc-a825-aecc80e887a5
https://lup.lub.lu.se/record/f13d3416-ce16-40fc-a825-aecc80e887a5URI
https://doi.org/10.3390/ijerph15040729DOI

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Language:English
Summary in:English &Swedish

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This is the first multi-district Standardised Patient (SP) study in South Africa. It measures the quality of TB screening at primary healthcare (PHC) facilities. We hypothesise that TB screening protocols and best practices are poorly adhered to at the PHC level. The SP method allows researchers to observe how healthcare providers identify, test and advise presumptive TB patients, and whether this aligns with clinical protocols and best practice. The study was conducted at PHC facilities in two provinces and 143 interactions at 39 facilities were analysed. Only 43% of interactions resulted in SPs receiving a TB sputum test and being offered an HIV test. TB sputum tests were conducted routinely (84%) while HIV tests were offered less frequently (47%). Nurses frequently neglected to ask SPs whether their household contacts had confirmed TB (54%). Antibiotics were prescribed without taking temperatures in 8% of cases. The importance of returning to the facility to receive TB test results was only explained in 28%. The SP method has highlighted gaps in clinical practice, signalling missed opportunities. Early detection of sub-optimal TB care is instrumental in decreasing TB-related morbidity and mortality. The findings provide the rationale for further quality improvement work in TB management.
This is the first multi-district Standardised Patient (SP) study in South Africa. It measures the quality of TB screening at primary healthcare (PHC) facilities. We hypothesise that TB screening protocols and best practices are poorly adhered to at the PHC level. The SP method allows researchers to observe how healthcare providers identify, test and advise presumptive TB patients, and whether this aligns with clinical protocols and best practice. The study was conducted at PHC facilities in two provinces and 143 interactions at 39 facilities were analysed. Only 43% of interactions resulted in SPs receiving a TB sputum test and being offered an HIV test. TB sputum tests were conducted routinely (84%) while HIV tests were offered less frequently (47%). Nurses frequently neglected to ask SPs whether their household contacts had confirmed TB (54%). Antibiotics were prescribed without taking temperatures in 8% of cases. The importance of returning to the facility to receive TB test results was only explained in 28%. The SP method has highlighted gaps in clinical practice, signalling missed opportunities. Early detection of sub-optimal TB care is instrumental in decreasing TB-related morbidity and mortality. The findings provide the rationale for further quality improvement work in TB management.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Hälsovetenskap Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi hsv//swe
MEDICAL AND HEALTH SCIENCES Health Sciences Health Care Service and Management, Health Policy and Services and Health Economy hsv//eng
quality of care
quality gaps
TB screening
standardised patients
South Africa

Added entries (persons, corporate bodies, meetings, titles ...)

Gerdtham, Ulf-GöranLund University,Lunds universitet,Nationalekonomiska institutionen,Ekonomihögskolan,Hälsoekonomi,Forskargrupper vid Lunds universitet,Department of Economics,Lund University School of Economics and Management, LUSEM,Health Economics,Lund University Research Groups(Swepub:lu)smi-uge (author)
Hompashe, DumisaniUniversity of Fort Hare,Stellenbosch University (author)
Smith, AnjaStellenbosch University (author)
Burger, RonelleStellenbosch University (author)
Stellenbosch UniversityUniversity of the Western Cape (creator_code:org_t)

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In:International Journal of Environmental Research and Public Health: MDPI AG15:41660-4601

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