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Health system factors influencing management of multidrug-resistant tuberculosis in four European Union countries - learning from country experiences
- Source :
- BMC Public Health, BMC Public Health, Vol 17, Iss 1, Pp 1-12 (2017)
- Publication Year :
- 2017
- Publisher :
- Springer Science and Business Media LLC, 2017.
-
Abstract
- Background In the European Union and European Economic Area only 38% of multidrug-resistant tuberculosis patients notified in 2011 completed treatment successfully at 24 months’ evaluation. Socio-economic factors and patient factors such as demographic characteristics, behaviour and attitudes are associated with treatment outcomes. Characteristics of healthcare systems also affect health outcomes. This study was conducted to identify and better understand the contribution of health system components to successful treatment of multidrug-resistant tuberculosis. Methods We selected four European Union countries to provide for a broad range of geographical locations and levels of treatment success rates of the multidrug-resistant tuberculosis cohort in 2009. We conducted semi-structured interviews following a conceptual framework with representatives from policy and planning authorities, healthcare providers and civil society organisations. Responses were organised according to the six building blocks of the World Health Organization health systems framework. Results In the four included countries, Austria, Bulgaria, Spain, and the United Kingdom, the following healthcare system factors were perceived as key to achieving good treatment results for patients with multidrug-resistant tuberculosis: timely diagnosis of drug-resistant tuberculosis; financial systems that ensure access to a full course of treatment and support for multidrug-resistant tuberculosis patients; patient-centred approaches with strong intersectoral collaboration that address patients’ emotional and social needs; motivated and dedicated healthcare workers with sufficient mandate and means to support patients; and cross-border management of multidrug-resistant tuberculosis to secure continuum of care between countries. Conclusion We suggest that the following actions may improve the success of treatment for multidrug-resistant tuberculosis patients: deployment of rapid molecular diagnostic tests; development of context-specific treatment guidance and criteria for hospital admission and discharge in the European context; strengthening patient-centred approaches; development of collaborative mechanisms to ensure cross-border care, and development of long-term sustainable financing strategies. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4216-9) contains supplementary material, which is available to authorized users.
- Subjects :
- Adult
Male
medicine.medical_specialty
Tuberculosis
Antitubercular Agents
Multidrug-resistance
Context (language use)
World Health Organization
03 medical and health sciences
0302 clinical medicine
Environmental health
Tuberculosis, Multidrug-Resistant
Health care
medicine
Humans
media_common.cataloged_instance
European Union
030212 general & internal medicine
European union
media_common
Medical Assistance
business.industry
lcsh:Public aspects of medicine
Public health
Healthcare systems
Public Health, Environmental and Occupational Health
lcsh:RA1-1270
Drug Resistance, Microbial
medicine.disease
Drug Resistance, Multiple
Government Programs
Treatment Outcome
030228 respiratory system
Conceptual framework
Family medicine
Mandate
Intersectoral Collaboration
business
Delivery of Health Care
Research Article
Subjects
Details
- ISSN :
- 14712458
- Volume :
- 17
- Database :
- OpenAIRE
- Journal :
- BMC Public Health
- Accession number :
- edsair.doi.dedup.....3dade89bdac0c772055b582d2d15f8e0