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How patients navigate the diagnostic ecosystem in a fragmented health system: a qualitative study from India
Background: Depending on a country’s diagnostic infrastructure, patients and providers play different roles in ensuring that correct and timely diagnosis is made. However, little is known about the work done by patients in accessing diagnostic services and completing the ‘test and treat’ loop. Objec...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Taylor & Francis
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5645647/ https://www.ncbi.nlm.nih.gov/pubmed/28762894 http://dx.doi.org/10.1080/16549716.2017.1350452 |
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author | Yellapa, Vijayashree Devadasan, Narayanan Krumeich, Anja Pant Pai, Nitika Vadnais, Caroline Pai, Madhukar Engel, Nora |
author_facet | Yellapa, Vijayashree Devadasan, Narayanan Krumeich, Anja Pant Pai, Nitika Vadnais, Caroline Pai, Madhukar Engel, Nora |
author_sort | Yellapa, Vijayashree |
collection | PubMed |
description | Background: Depending on a country’s diagnostic infrastructure, patients and providers play different roles in ensuring that correct and timely diagnosis is made. However, little is known about the work done by patients in accessing diagnostic services and completing the ‘test and treat’ loop. Objective: To address this knowledge gap, we traced the diagnostic journeys of patients with tuberculosis, diabetes, hypertension and typhoid, and examined the work they had to do to arrive at a diagnosis. Methods: This paper draws on a qualitative study, which included 78 semi-structured interviews and 13 focus group discussions with patients, public and private healthcare providers, community health workers, test manufacturers, laboratory technicians, program managers and policymakers. Data were collected between January and June 2013 in rural and urban Karnataka, South India, as part of a larger project on barriers to point-of-care testing. We reconstructed patient diagnostic processes retrospectively and analyzed emerging themes and patterns. Results: The journey to access diagnostic services requires a high level of involvement and immense work from patients and/or their caretakers. This process entails overcoming cost and distance, negotiating social relations, continuously making sense of their illness and diagnosis, producing and transporting samples, dealing with the social consequences of diagnosis, and returning results to the treating provider. The quality and content of interactions with providers were crucial for completion of test and treat loops. If the tasks became overwhelming, patients opted out, delayed being tested, switched providers and/or reverted to self-testing or self-treatment practices. Conclusion: Our study demonstrated how difficult it can be for patients to complete diagnostic journeys and how the health system works as far as diagnostics are concerned. If new point-of-care tests are to be implemented successfully, policymakers, program officers and test developers need to find ways to ease patient navigation through diagnostic services. |
format | Online Article Text |
id | pubmed-5645647 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Taylor & Francis |
record_format | MEDLINE/PubMed |
spelling | pubmed-56456472017-10-25 How patients navigate the diagnostic ecosystem in a fragmented health system: a qualitative study from India Yellapa, Vijayashree Devadasan, Narayanan Krumeich, Anja Pant Pai, Nitika Vadnais, Caroline Pai, Madhukar Engel, Nora Glob Health Action Original Article Background: Depending on a country’s diagnostic infrastructure, patients and providers play different roles in ensuring that correct and timely diagnosis is made. However, little is known about the work done by patients in accessing diagnostic services and completing the ‘test and treat’ loop. Objective: To address this knowledge gap, we traced the diagnostic journeys of patients with tuberculosis, diabetes, hypertension and typhoid, and examined the work they had to do to arrive at a diagnosis. Methods: This paper draws on a qualitative study, which included 78 semi-structured interviews and 13 focus group discussions with patients, public and private healthcare providers, community health workers, test manufacturers, laboratory technicians, program managers and policymakers. Data were collected between January and June 2013 in rural and urban Karnataka, South India, as part of a larger project on barriers to point-of-care testing. We reconstructed patient diagnostic processes retrospectively and analyzed emerging themes and patterns. Results: The journey to access diagnostic services requires a high level of involvement and immense work from patients and/or their caretakers. This process entails overcoming cost and distance, negotiating social relations, continuously making sense of their illness and diagnosis, producing and transporting samples, dealing with the social consequences of diagnosis, and returning results to the treating provider. The quality and content of interactions with providers were crucial for completion of test and treat loops. If the tasks became overwhelming, patients opted out, delayed being tested, switched providers and/or reverted to self-testing or self-treatment practices. Conclusion: Our study demonstrated how difficult it can be for patients to complete diagnostic journeys and how the health system works as far as diagnostics are concerned. If new point-of-care tests are to be implemented successfully, policymakers, program officers and test developers need to find ways to ease patient navigation through diagnostic services. Taylor & Francis 2017-08-01 /pmc/articles/PMC5645647/ /pubmed/28762894 http://dx.doi.org/10.1080/16549716.2017.1350452 Text en © 2017 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Yellapa, Vijayashree Devadasan, Narayanan Krumeich, Anja Pant Pai, Nitika Vadnais, Caroline Pai, Madhukar Engel, Nora How patients navigate the diagnostic ecosystem in a fragmented health system: a qualitative study from India |
title | How patients navigate the diagnostic ecosystem in a fragmented health system: a qualitative study from India |
title_full | How patients navigate the diagnostic ecosystem in a fragmented health system: a qualitative study from India |
title_fullStr | How patients navigate the diagnostic ecosystem in a fragmented health system: a qualitative study from India |
title_full_unstemmed | How patients navigate the diagnostic ecosystem in a fragmented health system: a qualitative study from India |
title_short | How patients navigate the diagnostic ecosystem in a fragmented health system: a qualitative study from India |
title_sort | how patients navigate the diagnostic ecosystem in a fragmented health system: a qualitative study from india |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5645647/ https://www.ncbi.nlm.nih.gov/pubmed/28762894 http://dx.doi.org/10.1080/16549716.2017.1350452 |
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