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. 2017 Apr 19;17(1):334.
doi: 10.1186/s12889-017-4216-9.

Health system factors influencing management of multidrug-resistant tuberculosis in four European Union countries - learning from country experiences

Gerard de Vries  1 , Svetla Tsolova  2 , Laura F Anderson  3 , Agnes C Gebhard  1 , Einar Heldal  1 , Vahur Hollo  4 , Laura Sánchez-Cambronero Cejudo  5 , Daniela Schmid  6 , Bert Schreuder  1 , Tonka Varleva  7 , Marieke J van der Werf  4
Affiliations

Health system factors influencing management of multidrug-resistant tuberculosis in four European Union countries - learning from country experiences

Gerard de Vries et al. BMC Public Health. .

Abstract

Background: In the European Union and European Economic Area only 38% of multidrug-resistant tuberculosis patients notified in 2011 completed treatment successfully at 24 months' evaluation. Socio-economic factors and patient factors such as demographic characteristics, behaviour and attitudes are associated with treatment outcomes. Characteristics of healthcare systems also affect health outcomes. This study was conducted to identify and better understand the contribution of health system components to successful treatment of multidrug-resistant tuberculosis.

Methods: We selected four European Union countries to provide for a broad range of geographical locations and levels of treatment success rates of the multidrug-resistant tuberculosis cohort in 2009. We conducted semi-structured interviews following a conceptual framework with representatives from policy and planning authorities, healthcare providers and civil society organisations. Responses were organised according to the six building blocks of the World Health Organization health systems framework.

Results: In the four included countries, Austria, Bulgaria, Spain, and the United Kingdom, the following healthcare system factors were perceived as key to achieving good treatment results for patients with multidrug-resistant tuberculosis: timely diagnosis of drug-resistant tuberculosis; financial systems that ensure access to a full course of treatment and support for multidrug-resistant tuberculosis patients; patient-centred approaches with strong intersectoral collaboration that address patients' emotional and social needs; motivated and dedicated healthcare workers with sufficient mandate and means to support patients; and cross-border management of multidrug-resistant tuberculosis to secure continuum of care between countries.

Conclusion: We suggest that the following actions may improve the success of treatment for multidrug-resistant tuberculosis patients: deployment of rapid molecular diagnostic tests; development of context-specific treatment guidance and criteria for hospital admission and discharge in the European context; strengthening patient-centred approaches; development of collaborative mechanisms to ensure cross-border care, and development of long-term sustainable financing strategies.

Keywords: European Union; Healthcare systems; Multidrug-resistance; Treatment outcome; Tuberculosis.

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Figures

Fig. 1
Fig. 1
Multidrug-resistant tuberculosis treatment outcome in European Union and European Economic Area countries after 24 months of 2011 cohort [3]. EEA = European Economic Area; EU = European Union. Successful refers to the combined treatment outcome categories cured and completed; other unsuccessful refers to the categories death, failure, lost to follow-up, still on treatment and not evaluated (transferred out and unknown). * In brackets the number of notified multidrug-resistant tuberculosis cases in 2011. ** Cyprus, Finland, France, Greece, Iceland, Italy, Liechtenstein, Luxembourg and Spain did not report treatment outcome of the 2010 cohort of multidrug-resistant cases
Fig. 2
Fig. 2
Conceptual framework of components of health system influencing MDR-TB treatment outcome
See this image and copyright information in PMC

References

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