Can community pharmacists improve tuberculosis case finding? A mixed methods intervention study in India
Introduction India has the world’s highest burden of tuberculosis (TB). Private retail pharmacies are the preferred provider for 40% of patients with TB symptoms and up to 25% of diagnosed patients. Engaging pharmacies in TB screening services could improve case detection.Methods A novel TB screenin...
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BMJ Publishing Group
2019-06-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/4/3/e001417.full |
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| author | Amrita Daftary Madhukar Pai Srinath Satyanarayana Nita Jha Mugdha Singh Shinjini Mondal Caroline Vadnais |
| author_facet | Amrita Daftary Madhukar Pai Srinath Satyanarayana Nita Jha Mugdha Singh Shinjini Mondal Caroline Vadnais |
| author_sort | Amrita Daftary |
| collection | DOAJ |
| description | Introduction India has the world’s highest burden of tuberculosis (TB). Private retail pharmacies are the preferred provider for 40% of patients with TB symptoms and up to 25% of diagnosed patients. Engaging pharmacies in TB screening services could improve case detection.Methods A novel TB screening and referral intervention was piloted over 18 months, under the pragmatic staggered recruitment of 105 pharmacies in Patna, India. The intervention was integrated into an ongoing public–private mix (PPM) programme, with five added components: pharmacy training in TB screening, referral of patients with TB symptoms for a chest radiograph (CXR) followed by a doctor consultation, incentives for referral completion and TB diagnosis, short message service (SMS) reminders and field support. The intervention was evaluated using mixed methods.Results 81% of pharmacies actively participated in the intervention. Over 132.49 pharmacy person-years of observation in the intervention group, 1674 referrals were made and 255 cases of TB were diagnosed. The rate of registration of symptomatic patients was 62 times higher in the intervention group compared with the control group (95% CI: 54 to 72). TB diagnosis was 25 times higher (95% CI: 20 to 32). Microbiological testing and test confirmation were also significantly higher among patients diagnosed in the intervention group (p<0.001). Perceived professional credibility, patient trust, symptom severity and providing access to a free screening test were seen to improve pharmacists’ engagement in the intervention. Workload, patient demand for over-the-counter medicines, doctor consultation fees and programme documentation impeded engagement. An additional 240 cases of TB were attributed to the intervention, and the approximate cost incurred per case detected due to the intervention was US$100.Conclusions It is feasible and impactful to engage pharmacies in TB screening and referral activities, especially if working within existing public-private mix (PPM) programmes, appealing to pharmacies’ business mindset and among pharmacies with strong community ties. |
| format | Article |
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| institution | OA Journals |
| issn | 2059-7908 |
| language | English |
| publishDate | 2019-06-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Global Health |
| spelling | doaj-art-2d424e76aa3346bd9acec50ca0d1e8a02025-08-20T01:56:46ZengBMJ Publishing GroupBMJ Global Health2059-79082019-06-014310.1136/bmjgh-2019-001417Can community pharmacists improve tuberculosis case finding? A mixed methods intervention study in IndiaAmrita Daftary0Madhukar Pai1Srinath Satyanarayana2Nita Jha3Mugdha Singh4Shinjini Mondal5Caroline Vadnais6Centre for the AIDS Programme of Research, Durban, KwaZulu-Natal, South AfricaEpidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, CanadaThe International Union Against Tuberculosis and Lung Disease (The Union), Paris, FranceWorld Health Partners, Patna, IndiaWorld Health Partners, Patna, Bihar, IndiaFamily Medicine, McGill University Faculty of Medicine, Montreal, Québec, CanadaResearch Institute of the McGill University Health Centre, Montreal, Québec, CanadaIntroduction India has the world’s highest burden of tuberculosis (TB). Private retail pharmacies are the preferred provider for 40% of patients with TB symptoms and up to 25% of diagnosed patients. Engaging pharmacies in TB screening services could improve case detection.Methods A novel TB screening and referral intervention was piloted over 18 months, under the pragmatic staggered recruitment of 105 pharmacies in Patna, India. The intervention was integrated into an ongoing public–private mix (PPM) programme, with five added components: pharmacy training in TB screening, referral of patients with TB symptoms for a chest radiograph (CXR) followed by a doctor consultation, incentives for referral completion and TB diagnosis, short message service (SMS) reminders and field support. The intervention was evaluated using mixed methods.Results 81% of pharmacies actively participated in the intervention. Over 132.49 pharmacy person-years of observation in the intervention group, 1674 referrals were made and 255 cases of TB were diagnosed. The rate of registration of symptomatic patients was 62 times higher in the intervention group compared with the control group (95% CI: 54 to 72). TB diagnosis was 25 times higher (95% CI: 20 to 32). Microbiological testing and test confirmation were also significantly higher among patients diagnosed in the intervention group (p<0.001). Perceived professional credibility, patient trust, symptom severity and providing access to a free screening test were seen to improve pharmacists’ engagement in the intervention. Workload, patient demand for over-the-counter medicines, doctor consultation fees and programme documentation impeded engagement. An additional 240 cases of TB were attributed to the intervention, and the approximate cost incurred per case detected due to the intervention was US$100.Conclusions It is feasible and impactful to engage pharmacies in TB screening and referral activities, especially if working within existing public-private mix (PPM) programmes, appealing to pharmacies’ business mindset and among pharmacies with strong community ties.https://gh.bmj.com/content/4/3/e001417.full |
| spellingShingle | Amrita Daftary Madhukar Pai Srinath Satyanarayana Nita Jha Mugdha Singh Shinjini Mondal Caroline Vadnais Can community pharmacists improve tuberculosis case finding? A mixed methods intervention study in India BMJ Global Health |
| title | Can community pharmacists improve tuberculosis case finding? A mixed methods intervention study in India |
| title_full | Can community pharmacists improve tuberculosis case finding? A mixed methods intervention study in India |
| title_fullStr | Can community pharmacists improve tuberculosis case finding? A mixed methods intervention study in India |
| title_full_unstemmed | Can community pharmacists improve tuberculosis case finding? A mixed methods intervention study in India |
| title_short | Can community pharmacists improve tuberculosis case finding? A mixed methods intervention study in India |
| title_sort | can community pharmacists improve tuberculosis case finding a mixed methods intervention study in india |
| url | https://gh.bmj.com/content/4/3/e001417.full |
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