{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T10:50:26Z","timestamp":1740135026508,"version":"3.37.3"},"reference-count":31,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2019,11,19]],"date-time":"2019-11-19T00:00:00Z","timestamp":1574121600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,11,19]],"date-time":"2019-11-19T00:00:00Z","timestamp":1574121600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001869","name":"Academia Sinica","doi-asserted-by":"publisher","award":["Multidisciplinary Health Cloud Research Program: Technology Development and Application of Big Health Data"],"award-info":[{"award-number":["Multidisciplinary Health Cloud Research Program: Technology Development and Application of Big Health Data"]}],"id":[{"id":"10.13039\/501100001869","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Taiwan CDC","award":["MOHW106-CDC-114-000101"],"award-info":[{"award-number":["MOHW106-CDC-114-000101"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Health Serv Res"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>The decline of the incidence rate of tuberculosis in Taiwan has been partly attributed to the launch of the directly observed therapy short course (DOTS) program in 2006, followed by the DOTS-Plus in 2007. However, with the phasing out of the specialized tuberculosis care system and the declining incidence, clinical workers in Taiwan might become less familiar with the presentation of tuberculosis. Complementing the patient-pathway analysis with health system delay estimates, the objective of this study is twofold: to estimate the alignment between patient care initiation and the availability of prompt diagnostic and treatment services, and to identify the risk factors of delayed tuberculosis treatment.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>The study population included all Taiwanese patients with incident tuberculosis in 2013. We (1) identified 11,507 incident tuberculosis patients from the 2013 National TB Registry, and (2) linked 10,932 Taiwanese from the registry to the 2012\u20132013 National Health Insurance Research Database. We assessed patient\u2019s care-seeking pathways and associated the determinants of health system delay in a Cox model.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>The overall health system delay was 46\u2009days. We found that 20.5 and 3.5% of 10,932 tuberculosis patients were diagnosed and treated respectively at the initial visit to seek care for TB-related symptoms. Risk factors related to the prolonged health system delay included female gender (adjusted HR\u2009=\u20090.921, 95% CI: 0.884, 0.960), age\u2009&gt;\u2009=65\u2009years (adjusted HR\u2009=\u20090.720, 95% CI: 0.692, 0.750), non-severe (chest X-ray without cavities) (adjusted HR =0.721, 95% CI 0.683\u20130.760), chronic respiratory diseases (adjusted HR\u2009=\u20090.544, 95% CI: 0.522, 0.566), living in long-term care facilities (adjusted HR\u2009=\u20090.580, 95% CI: 0.525,0.640), an initial visit at a primary care clinic (adjusted HR\u2009=\u20090.588, 95% CI: 0.565, 0.612), and living in southern Taiwan (adjusted HR\u2009=\u20090.887, 95% CI: 0.798, 0.987).<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The low access to TB diagnostic and treatment services at the initial visit and the prolonged health system delay indicate inefficiency in the health care system. Strengthening training of physicians at public hospitals and health workers at nursing homes might improve the efficiency and timeliness of tuberculosis diagnosis and treatment in Taiwan.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12913-019-4702-0","type":"journal-article","created":{"date-parts":[[2019,11,19]],"date-time":"2019-11-19T06:03:03Z","timestamp":1574143383000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Patient and health care system characteristics are associated with delayed treatment of tuberculosis cases in Taiwan"],"prefix":"10.1186","volume":"19","author":[{"given":"Chien-Chou","family":"Chen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Po-Huang","family":"Chiang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yen-Hsu","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"I-Chun","family":"Fan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1685-783X","authenticated-orcid":false,"given":"Ta-Chien","family":"Chan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2019,11,19]]},"reference":[{"issue":"9","key":"4702_CR1","first-page":"1006","volume":"9","author":"CY Chiang","year":"2005","unstructured":"Chiang CY, Chang CT, Chang RE, Li CT, Huang RM. 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In addition, we applied the data from Health and Welfare Data Science Center, Ministry of Health and Welfare, Taiwan and got the permission for analyzing the data. The data used in this study were derived from linkage of two databases including the National Health Insurance Research Database (NHIRD) and the TB registry. The data were all analyzed anonymously. Therefore, we did not need to get consent from each patient.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not Applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"846"}}