Measuring quality gaps in TB screening in South Africa using standardised patient analysis
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Date
2018
Journal Title
Journal ISSN
Volume Title
Publisher
MPDI
Abstract
This is the first multi-district Standardised Patient (SP) study in South Africa. It measures
the quality of TB screening at primary healthcare (PHC) facilities. We hypothesise that TB screening
protocols and best practices are poorly adhered to at the PHC level. The SP method allows researchers
to observe how healthcare providers identify, test and advise presumptive TB patients, and whether
this aligns with clinical protocols and best practice. The study was conducted at PHC facilities in two
provinces and 143 interactions at 39 facilities were analysed. Only 43% of interactions resulted in SPs
receiving a TB sputum test and being offered an HIV test. TB sputum tests were conducted routinely
(84%) while HIV tests were offered less frequently (47%). Nurses frequently neglected to ask SPs
whether their household contacts had confirmed TB (54%). Antibiotics were prescribed without
taking temperatures in 8% of cases. The importance of returning to the facility to receive TB test
results was only explained in 28%. The SP method has highlighted gaps in clinical practice, signalling
missed opportunities. Early detection of sub-optimal TB care is instrumental in decreasing TB-related
morbidity and mortality. The findings provide the rationale for further quality improvement work in
TB management.
Description
Keywords
Quality of care, Quality gaps, TB screening, Standardised patients, South Africa
Citation
Christian, C. S. et al. (2018). Measuring quality gaps in TB screening in South Africa using standardised patient analysis. International Journal of Environment Research and Public Health15(4), 729,