Pharmacists can be crucial in helping track undiagnosed tuberculosis (TB) patients in the country as for most sick patients, they are the first point of contact, a new study published in BMJ Global Health has revealed.
The study, “Can community pharmacists improve tuberculosis case finding? A mixed methods intervention study in India”, showed that engaging pharmacies in TB screening services could improve case detection.
The pilot study was conducted among 105 pharmacists over 18 months in Patna, Bihar, where the incidence of TB is as high as 326 per one lakh population, as opposed to the current India estimates of 204 new cases per one-lakh population.
The rate of registration of symptomatic patients was 62 times higher in the intervention group as compared with the control group, and TB diagnosis was 25 times higher.
“The idea behind the study was to help find the ‘missing’ TB patients. That is patients who have TB but are not yet diagnosed. And to tap into the trust and relationship that many people in the community have with their pharmacy providers,” said Amrita Daftary, McGill International TB Centre and Department of Epidemiology & Biostatistics, one of the authors of the study.
“As you can imagine it is much easier for a person to walk up to a chemist shop and seek advice than wait in line or pay a fee to see a doctor. Hence we saw pharmacies as important gatekeepers between the community and health care system,” she said.
Currently, pharmacies have the option of referring patients with TB-like symptoms to doctors for TB testing, but according to the researchers, the rate of these referrals is very low. Also, most sick patients prefer taking over-the-counter medicines from a pharmacy rather than visit a doctor for consultation, leading to delay in TB diagnosis.
“We decided to improve rate of pharmacy referrals to doctors to improve the rate and timeliness of TB diagnosis. But to motivate pharmacies — and patients — to buy in to this idea we armed pharmacies with the ability to dispense a free chest X-ray at the point of care of pharmacies for all adult patients presenting with classic signs of TB (2-3 weeks of unresolved cough)… by dispensing a screening rather than dispensing an OTC drug we were hoping to improve testing and diagnostic delay,” said Amrita Daftary.
A section of experts, however, has expressed reservations about the idea.
“These days we don’t diagnose and treat patients only on the basis of an x-ray. We prefer getting the sputum analysis done also before diagnosing and putting a patient on treatment,” said Dr Vivek Nangia, director, pulmonology, Fortis Healthcare.
May 18, 2019 01:54 IST