'75% TB patients visiting pvt docs treated incorrectly'

Nearly 75% of Indian tuberculosis patients visiting private doctors are not treated according to the standard protocol, says a new research that has red-flagged areas of concern on the quality of TB treatment delivered by private healthcare sector.

Health researchers say the findings are of public health concern because India has the world's highest burden of TB, and the private sector is the first pit stop for 50-70% patients, and improper management can worsen the disease and threaten public health.

The study looks at the responses from qualified doctors and low-grade care providers, many of whom are either quacks or AYUSH practitioners. They were repeating the mistakes 75% of the time, deviating from the standard case management practice they should follow.

“The quality of TB care is sub-optimal and variable in urban India's private health sector. Improving the quality of TB management in private sector must be a priority for India's TB elimination strategy,” says the study published in the journal PLOS Medicine.

The alarm is raised on the eve of the maiden TB summit at the United Nations General Assembly on September 26, where nations will discuss their elimination strategies.

Earlier this year, India announced its ambitious plans to eliminate the disease by 2025, but its success would depend much on private doctors who get to see the maximum number of patients.

To check the quality of care, the researchers recruited 24 decoy patients — healthy adults — who were to present themselves before doctors in Mumbai and Patna between 2014 and 2017 narrating their stories as suspected TB cases.

They were coached to give out four types of scenario — (1) naive suspected TB, (2) suspected TB with abnormal chest X-ray, (3) TB case, (4) suspected drug-resistant cases. Necessary documents and X-ray plates and old prescriptions were provided by the researchers.

The decoy patients reported back to the researchers whether the doctors and caregivers followed the correct case management procedures. Only in 26% cases in Mumbai and 19% cases in Patna were correct practices followed.

“Unnecessary medicines were given to nearly all decoy patients and antibiotic use was common,” says the paper. At least one in 10 patients was also given steroids.

“The study used the mystery-patient method (standardised patients) to see what happens when we send such patients to private clinics and facilities. The results don’t look good — only a third of them were managed correctly,” Madhukar Pai, director, McGill International TB Centre at McGill University, Canada, and principal investigator of the study told DH.

The number of TB patients being managed correctly shrunk further if one looks at the case management protocol for TB and suspected drug-resistant cases.

The study comes days after the World Health Organisation's latest report on TB pointed out that the treatment outcome for TB patients in India's private healthcare sector is largely unknown.