Community pharmacists can help in detecting undiagnosed cases of tuberculosis (TB), as they are the first point of contact for many sick patients, a new study in Patna has found. The study found that pharmacies trained in TB screening that referred patients with TB to doctors led to higher rates of diagnosis and registration of symptomatic patients.
Amrita Daftary, lead researcher from McGill International Tuberculosis Centre and Department of Epidemiology and Biostatistics at McGill University, Canada, told The Indian Express, “On an average, a tuberculosis patient experiences a delay of 55 days before being diagnosed and undergoing treatment. So, taking steps to strengthen symptom screening and diagnosis is a priority.”
The study, which was published in BMJ-Global Health in April, shows that it is feasible and impactful to engage pharmacies in TB screening and referral.
In India, up to 40 per cent of patients with TB symptoms visit pharmacies as the first point of medical contact, but are seldom referred for TB screening and testing services.
But, the researchers implemented a TB screening and referral intervention programme via the staggered recruitment of 105 pharmacies engaged in a public-private mix (PPM) programme in Patna over 18 months between 2015 and 2017.
The intervention was integrated into an ongoing PPM programme with five added components: pharmacy training in TB screening, referral of patients with TB symptoms for a chest radiograph (CXR) followed by a doctor consultation, incentives for referral completion and TB diagnosis, SMS reminders and field support. The intervention was evaluated using mixed methods.
The findings showed that the rates of registration of symptomatic patients were 62 times higher in the intervention group compared to the control group, TB diagnosis was 25 times higher, and microbiological testing and test confirmation were also higher.
At least 81 per cent of pharmacies actively participated in the intervention. A total of 1,674 referrals were made and 255 TB cases were diagnosed during the study period. Perceived professional credibility, patient trust, severity of symptoms and providing access to a free screening test were seen to improve pharmacists’ engagement in the intervention, Prof Madhukar Pai, director, McGill International TB Centre, who was one of the researchers in the study, told The Indian Express.
Private pharmacies in India have been engaged in TB treatment education, screening and referral initiatives within PPM projects but participation has been low. Studies have also shown that pharmacy providers commonly dispense cough syrups, anti-histamines, bronchodilators and antibiotics over-the-counter, rather than refer patients to a doctor for TB testing and treatment. Self-medication and poor referral practices can delay TB diagnosis and the overuse of broad-spectrum antibiotics such as fluoroquinolones may also lead to TB drug resistance, Prof Pai explained.
According to Daftary, the model of capitalising on the patient-pharmacy provider bond to funnel people with TB into the healthcare system can be applied to other parts of the country. “The model should be integrated into ongoing public private partnership programmes that involve doctors and labs in the private sector and not just pharmacies,” said Daftary.
Researchers said they referred patients in Patna for a chest X ray because this was the first test ordered by doctors. “In other parts of the country, a sputum test might be more helpful and the model can be tailored accordingly,” added Daftary.