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Prescribing practices for presumptive TB among private general practitioners in South Africa: a cross-sectional, standardised patient study
- Source :
- BMJ Global Health, Vol 7, Iss 1 (2022), BMJ global health, vol 7, iss 1, BMJ Global Health
- Publication Year :
- 2022
- Publisher :
- BMJ Publishing Group, 2022.
-
Abstract
- IntroductionMedicine prescribing practices are integral to quality of care for leading infectious diseases such as tuberculosis (TB). We describe prescribing practices in South Africa’s private health sector, where an estimated third of people with TB symptoms first seek care.MethodsSixteen standardised patients (SPs) presented one of three cases during unannounced visits to private general practitioners (GPs) in Durban and Cape Town: TB symptoms, HIV-positive; TB symptoms, a positive molecular test for TB, HIV-negative; and TB symptoms, history of incomplete TB treatment, HIV-positive. Prescribing practices were recorded in standardised exit interviews and analysed based on their potential to contribute to negative outcomes, including increased healthcare expenditures, antibiotic overuse or misuse, and TB diagnostic delay. Factors associated with antibiotic use were assessed using Poisson regression with a robust variance estimator.ResultsBetween August 2018 and July 2019, 511 SP visits were completed with 212 GPs. In 88.5% (95% CI 85.2% to 91.1%) of visits, at least one medicine (median 3) was dispensed or prescribed and most (93%) were directly dispensed. Antibiotics, which can contribute to TB diagnostic delay, were the most common medicine (76.5%, 95% CI 71.7% to 80.7% of all visits). A majority (86.1%, 95% CI 82.9% to 88.5%) belonged to the WHO Access group; fluoroquinolones made up 8.8% (95% CI 6.3% to 12.3%). Factors associated with antibiotic use included if the SP was asked to follow-up if symptoms persisted (RR 1.14, 95% CI 1.04 to 1.25) and if the SP presented as HIV-positive (RR 1.11, 95% CI 1.01 to 1.23). An injection was offered in 31.9% (95% CI 27.0% to 37.2%) of visits; 92% were unexplained. Most (61.8%, 95% CI 60.2% to 63.3%) medicines were not listed on the South African Primary Healthcare Essential Medicines List.ConclusionPrescribing practices among private GPs for persons presenting with TB-like symptoms in South Africa raise concern about inappropriate antimicrobial use, private healthcare costs and TB diagnostic delay.
- Subjects :
- Medicine (General)
Delayed Diagnosis
Clinical Trials and Supportive Activities
8.1 Organisation and delivery of services
Infectious and parasitic diseases
RC109-216
7.3 Management and decision making
South Africa
R5-920
General Practitioners
Clinical Research
Humans
Lung
Original Research
Health Policy
screening
Public Health, Environmental and Occupational Health
HIV
health services research
Cross-Sectional Studies
Prescriptions
Infectious Diseases
Good Health and Well Being
tuberculosis
HIV/AIDS
epidemiology
Management of diseases and conditions
Infection
Health and social care services research
Subjects
Details
- Language :
- English
- ISSN :
- 20597908
- Volume :
- 7
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- BMJ Global Health
- Accession number :
- edsair.doi.dedup.....9e4e47e7b49151db4b589d0c87d25c73