Tamae Shimamura

OBJECTIVES: As the number of tuberculosis (TB) cases has decreased, early diagnosis of TB has become more difficult. Delayed diagnosis of TB may lead to worsening of the affected individual's condition and may spread the disease in the community. The purpose of this study was to find factors associated with patient delay in seeking treatment after developing symptoms of TB. METHODS: Structured interviews were conducted with adult TB patients from 17 health centers registered under the national Japanese TB surveillance system from January 1, 2010 to November 30, 2010. The questionnaire used for the interview included items on symptoms, type of coping behavior from the time of onset of symptoms to the time of the first hospital visit, recognition of and experience with TB, priorities in terms of health behavior, and demographic characteristics of the patients. RESULTS: Among the 60 patients interviewed, only 53 patients' data were analyzed. Seven patients were excluded from analysis because they had no symptoms, were non-Japanese, had extrapulmonary tuberculosis, or were undergoing retreatment. The mean age of the patients was 60.2 +/- 19.2 (mean +/- SD) years. Twenty-two patients (41.5%) visited a hospital after a gap of more than two months from the time of onset of their symptoms (hereafter referred to as "patient delay"). Factors associated with patient delay were presence of sputum and hemoptysis, positive sputum smear, low priority given to health, lack of a family physician, lack of consultation, taking over-the-counter drugs, and disliking hospital visits. CONCLUSION: Factors associated with patients' seeking medical treatment more than two months after developing symptoms of TB included taking over-the-counter drugs disliking hospital visits and not consulting health professionals or the people around them. In order to prevent patient delay, our findings suggest the following actions. Health care professionals need to provide information about symptoms of tuberculosis and the merits of early hospital visits to patients. It is also necessary for health care professionals in public health centers, etc., to communicate the need to have people available whom patients can consult regarding their symptoms and receive appropriate advices or secure appropriate treatment when they have symptoms of tuberculosis.