STEPS - a patient centric and low-cost solution to ensure standards of TB care to patients reaching private sector in India.

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  • Additional Information
    • Source:
      Publisher: BioMed Central Country of Publication: England NLM ID: 101088677 Publication Model: Electronic Cited Medium: Internet ISSN: 1472-6963 (Electronic) Linking ISSN: 14726963 NLM ISO Abbreviation: BMC Health Serv Res Subsets: MEDLINE
    • Publication Information:
      Original Publication: London : BioMed Central, [2001-
    • Subject Terms:
      Private Sector* ; Tuberculosis*/diagnosis ; Tuberculosis*/epidemiology ; Tuberculosis*/therapy; Hospitals, Private ; Humans ; India/epidemiology ; Patient-Centered Care
    • Abstract:
      Background: More than half of the TB patients in India seek care from the private sector. Two decades of attempts by the National TB Program to improve collaboration between the public and private sectors have not worked except in a few innovative pilots. The System for TB Elimination in Private Sector (STEPS) evolved in 2019 as a solution to ensure standards of TB care to every patient reaching the private sector. We formally evaluated the STEPS to judge the success of the model in achieving its outcomes and to inform decisions about scaling up of the model to other parts of the country.
      Methods: An evaluation team was constituted involving all relevant stakeholders. A logic framework for the STEPS model was developed. The evaluation focused on (i) processes - whether the activities are taking place as intended and (ii) proximal outcomes - improvements in quality of care and strengthening of TB surveillance system. We (i) visited 30 randomly selected STEPS centres for assessing infrastructure and process using a checklist, (ii) validated the patient data with management information system of National TB Elimination Program (NTEP) by telephonic interview of 57 TB patients (iii) analysed the quality of patient care indicators over 3 years from the management information system (iv) conducted in-depth interviews (IDI) with 33 beneficiaries and stakeholders to understand their satisfaction and perceived benefits of STEPS and (v) performed cost analysis for the intervention from the perspective of NTEP, private hospital and patients.
      Results: Evaluation revealed that STEPS is an acceptable model to all stakeholders. IDIs revealed that all patients were satisfied about the services received. Data in management information system of NTEP were consistent with the hospital records and with the information provided by the patient. Quality of TB care indicators for patients diagnosed in private hospitals showed improvements over years as proportion of TB patients notified from private sector with a microbiological confirmation of diagnosis improved from 25% in 2018 to 38% in 2020 and the documented treatment success rate increased from 33% (2018 cohort) to 88% (2019 cohort). Total additional programmatic cost (deducting cost for patient entitlements) per additional patient with successful treatment outcome was estimated to be 67 USD. Total additional expense/business loss for implementing STEPS for the hospital diagnosing 100 TB patients in a year was estimated to be 573 USD while additional minimum returns for the hospital was estimated to be 1145 USD.
      Conclusion: Evaluation confirmed that STEPS is a low cost and patient-centric strategy. STEPS successfully addressed the gaps in the quality of care for patients seeking care in the private sector and ensured that services are aligned with the standards of TB care. STEPS could be scaled up to similar settings.
      (© 2021. The Author(s).)
    • References:
      Indian J Tuberc. 2020 Apr;67(2):189-201. (PMID: 32553311)
      Int J Tuberc Lung Dis. 2005 Aug;9(8):870-6. (PMID: 16104633)
      Glob Health Sci Pract. 2021 Jul 1;9(2):286-295. (PMID: 34038380)
      PLoS One. 2019 Jun 5;14(6):e0214928. (PMID: 31166942)
      Lancet Infect Dis. 2016 Nov;16(11):1255-1260. (PMID: 27568356)
      Public Health Action. 2017 Dec 21;7(4):308. (PMID: 29344443)
      Lancet Infect Dis. 2015 Nov;15(11):1305-13. (PMID: 26268690)
      BMJ Glob Health. 2019 Nov 28;4(6):e001539. (PMID: 31908854)
      MMWR Recomm Rep. 1999 Sep 17;48(RR-11):1-40. (PMID: 10499397)
      Int J Tuberc Lung Dis. 2015 Jul;19(7):751-63. (PMID: 26056098)
      J Family Med Prim Care. 2019 Jan;8(1):160-165. (PMID: 30911499)
    • Publication Date:
      Date Created: 20220103 Date Completed: 20220104 Latest Revision: 20231105
    • Publication Date:
      20240105
    • Accession Number:
      PMC8720462
    • Accession Number:
      10.1186/s12913-021-07342-y
    • Accession Number:
      34974843