Tuberc Respir Dis.  2009 May;66(5):349-357. 10.4046/trd.2009.66.5.349.

A Public-Private Collaboration Model for Treatment Intervention to Improve Outcomes in Patients with Tuberculosis in the Private Sector

• Kim HJ
• Bai GH
• Kang MK
• Kim SJ
• Lee JK
• Cho SI
• Lew WJ

• KMID: 1846397
• DOI: http://doi.org/10.4046/trd.2009.66.5.349

Abstract

BACKGROUND: The treatment success rates in patients with tuberculosis are known to be lower in the private sector compared to the public sector. To improve treatment outcomes in the private sector we developed a public-private collaboration model for strengthening health education and case holding activities with public health nursing in the private sector.
METHODS
We performed a prospective cohort study in new smear positive pulmonary tuberculosis patients treated at private hospitals, selected by non-randomization, with an intervention consisting of health education and case holding activities by specially trained public health nurses (intervention group) results were compared with cases treated without the intervention (conventional group). Physicians were asked to treat both groups routinely. The treatment outcomes of patients under treatment by the National Tuberculosis Programme were also analyzed for comparison.
RESULTS
There were 172 cases each in the intervention and conventional groups. The mean age was 48.9+/-19.0 and 48.2+/-19.7 in the respective groups (p=0.66). The PHN interacted with the cases in the intervention group by initial face to face interview and telephone calls an average of 7.1+/-9.2 times during the initial six months. The intervention group showed a significantly higher treatment success rate, 91.6%, (Rate Ratio [RR]; 1.23, 95% Confidence Interval [CI]; 1.12~1.36), lower default, 3.6%, (RR; 0.31, 95% CI; 0.13~0.75) and transfer-out rate, 3.0%, (RR; 0.32, 95% CI; 0.12~0.86) than the conventional group where they were: 75.0%, 11.6%, 9.3%, respectively. The success rate was even higher than the rate (80.5%) of 1,027 cases treated in health centers (RR; 1.11, 95% CI; 1.05~1.17). Of the completed cases in the intervention group, 82.2% regarded the role of the public health nurse as very helpful.
CONCLUSION
The treatment success rate, of tuberculosis patients in the private sector, was significantly improved by an intervention using a public-private collaboration model.

Keyword

Tuberculosis; Case holding activities; Treatment success; Public-private collaboration

MeSH Terms

Cohort Studies
Cooperative Behavior
Health Education
Hospitals, Private
Humans
Private Sector
Prospective Studies
Public Health Nursing
Public Sector
Telephone
Tuberculosis
Tuberculosis, Pulmonary

Figure

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  Figure 1 Frequency of contact with public health nurse in the intervention group: cases with successful outcome.

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