Conducting Patient-Pathway Analysis to Inform Programming of Tuberculosis Services: Methods

Abstract

Patient-centered care is a central pillar of the World Health Organization's End TB Strategy. Understanding where patients access health services is a first step to planning for the placement of services to meet patient needs and preferences. The patient-pathway analysis (PPA) methodology detailed in this article was developed to better understand the alignment between patient care seeking and tuberculosis service availability. A PPA describes the steps that people with tuberculosis take from the initial care visit to cure. The results of a PPA reveal programmatic gaps in care seeking, diagnosis, treatment initiation, and continuity of care. They can be used as inputs to an evidence-based process of identifying and developing interventions to address the gaps in patient care. This paper summarizes the steps to conduct a PPA and serves as the basis for understanding country case studies that profile the use of PPA.

Keywords: care seeking; diagnosis; patient pathway analysis; private sector; tuberculosis.

Figure 1.

Assessing alignment of patient care seeking and health systems. An analysis of the alignment of tuberculosis patient care-seeking and health service delivery can help programs to identify gaps that can be closed through prioritized and targeted planning. The assessment results should be considered one input into a process of better understanding your tuberculosis epidemic and planning based on evidence.

Figure 2.

Demo patient-pathway visual. The patient-pathway analysis visual describes several potential steps along a patient’s journey for tuberculosis care. The first column shows where patients initiate their care-seeking journey across different sectors and levels of the healthcare system. Column 2 estimates the percentage of health facilities at each level and sector that have microscopy available in the facility. Column 3 estimates the likelihood that a patient will start their care-seeking journey at a facility that has diagnostic tools available. This is calculated by multiplying the share of patients who seek care (column 1) at each sector and level by the microscopy coverage. The fourth column shows the coverage of tuberculosis treatment services at each sector and level of the health system. Similar to column 3, column 5 estimates the likelihood of a patient starting their care-seeking journey in a facility that has tuberculosis treatment services available. This is calculated by multiplying care seeking at each sector and level (column 1) by the coverage of tuberculosis treatment services (column 4). The final 2 columns show the location of notification and treatment outcomes of notified patients as a share of the overall tuberculosis burden.