Delay in diagnosis of pulmonary tuberculosis: A survey in the Lazio region, Italy

Abstract

Background: To estimate patient and health care delays in the ,diagnosis of pulmonary tuberculosis (PTB) and evaluate associated factors. Methods: PTB incident cases ≥18 years diagnosed between September 2010 and September 2011 in the Lazio region; information on symptoms,date of onset, health professional contacts, diagnostic exams performed and drugs prescribed before diagnosis were collected through a standardized questionnaire. The total delay (TD) was divided into patient delay (PD: from onset of symptoms to first contact with healthcare services) and health system delay (HSD: from first contact to diagnosis). Results: Two hundred seventy-eight cases were evaluated. Median PD,HSD and TD were 31, 15 and 77.5 days, respectively. The median PD, HSD and TD were significantly lower in foreign-born patients (26, 10.5 and 63.5 vs. 45, 36 and 100 days, respectively). Other factors independently associated with longer delay were: absence of fever and presence of weight loss for PD; prior unspecific treatment, absence of cough, consultation with a general practitioner, visit atan outpatient clinic and a PD <30 days for HSD. ConclusionS: In Italy, the delay ofTB diagnosis is similar to that estimated in other European countries. Results indicate that actions aimed to reduce diagnostic delay should be primarily addressed to Italian patients