Effect of first visit to different levels of medical institutions on diagnostic and treatment delays in pulmonary tuberculosis in Ningxia, China: a cross-sectional study from 2015 to 2019.

OBJECTIVE: We aimed to investigate the effect of first visit to different levels of medical institutions on diagnostic and treatment delays of pulmonary tuberculosis (PTB) patients, assess the current situation and potential problems of different-level medical institutions, and put forward constructive recommendations for policy-making to reduce the delayed behaviours among PTB patients in the Ningxia Hui Autonomous Region (NHAR).

SETTING: NHAR, China.

DESIGN: We collected information on all PTB patients in the NHAR identified through China's National Tuberculosis Information Management System (TBIMS) between 2015 and 2019. Propensity score matching (PSM) was used to create balanced data excluding the effects of covariates. The inverse probability of treatment weight was used to verify the robustness of the PSM results. Binary logistic regression was used to assess the correlation between first-visit medical institution levels and diagnostic and treatment delays.

MAIN OUTCOME MEASURES: Diagnostic and treatment delays of PTB patients.

PARTICIPANTS: We collected 11 202 confirmed PTB cases from TBIMS during 2015-2019.

RESULTS: Among 11 202 confirmed PTB cases, 1497 (13.4%) had diagnostic delays, with a median diagnostic delay of 1 day (IQR: 0-7 days). Among 7593 PTB cases, 1056 (13.9%) had treatment delays, with a median treatment delay of 0 days (IQR: 0-1 days). After adjustment by propensity value matching, the possibility of diagnostic delay (OR=0.84, 95% CI 0.72 to 0.99) and treatment delay (OR 0.37, 95% CI 0.32 to 0.44) of county medical institutions was significantly higher than that of above-municipal medical institutions.

CONCLUSIONS: More effective measures should be implemented to improve rapid diagnosis and treatment technology and the capacity of county medical institutions, clarify the referral process and reduce the occurrence of delayed behaviours.