Title : Using unannounced standardized patients to assess quality of tuberculosis care and antibiotic prescribing: A cross-sectional study from a low-middle income country, Pakistan
Abstract:
Background: Pakistan is a high-burden country for tuberculosis patients, and medicines and fluoroquinolones hinder diagnosis. The available literature largely uses knowledge surveys and prescription or medical record analysis to assess healthcare practitioners' knowledge rather than their practices. Thus, we assessed Tuberculosis care with standardized patients.
Methods: We did pilot cross-sectional research on conveniently recruited consenting private healthcare practitioners in four Punjab cities, Pakistan. Using standardized patients from the general population, we submitted four cases: two presumed, one proven, and one suspected multidrug-resistant. The best treatment for Cases 1 and 2 is sputum testing, chest X-ray, or short-term direct observation at a public institution. Treat standardized case 3 with four anti-TB drugs and recommend a drug-susceptibility test for Case 4. The differences in referrals, optimal case management, antibiotic use, steroid use, and drug number were examined using descriptive statistics in SPSS version 23.
Results: Between July 2022 to May 2023 a total of 3321 standardized cases were presented to private care practitioners. The overall ideal case management for Tuberculosis patients were 39.4% which is highest for Case 3 (56.7%) and lowest in terms of Case 4 (19.8%). City wise disparity showed that highest management of all the four cases were seen in Rawalpindi (55.8%) and lowest was observed in Sialkot (30.6%). Highest amount of antibiotics were prescribed for Case1 and least for Case 4 and same is the case with fluoroquinolones. Anti-TB medications were also seen prescribed in naïve and suspected TB case (8.3% Case 1 and 10.8% Case 2).
Conclusion: Ideal management of Tuberculosis is low in actual practices among providers. Also, dispensation of antibiotics, fluoroquinolones and anti-TB drugs in patient was high which is threat for the resistance in TB.
