Healthcare-seeking pathway and delay analysis of rifampicin-resistant tuberculosis patient in Southwestern China.

OBJECTIVES

Rifampicin-resistant tuberculosis (RR-TB) remains a critical health challenge in southwest China. This study investigates healthcare-seeking delays and patient pathways among RR-TB patients in Yunnan province, employing diagram visualization. Aim to explore the accessibility and challenges of medical services for RR-TB.

METHODS

A retrospective cohort study was conducted among RR-TB patients who were enrolled in the Tuberculosis Management Information System (TBMIS) from 2020 to 2022. Data was collected via a face-to-face questionnaire survey to measure the patient pathways and delays of RR-TB patients at different health facility levels. SPSS statistical software was used for descriptive statistics, nonparametric tests, and patient pathway analysis. Sankey diagram, box plot and a heat map were used for data visualization.

RESULTS

Sankey diagrams revealed 7 distinct diagnostic pathways, with 49.4% diagnosed after one health facility visit. Over 50% of patients were diagnosed at county level facilities (Level 2), prolonging delays. As the level of health facility increases, the flow of RR-TB patients gradually decreased. Treatment pathways were simple with 4 routes. 92.4% of RR-TB patients enrolled treatment after visiting only one health facility, reflecting shorter treatment delays (median: 5 days). The median total delay was 66 days (Interquartile range: 28 to 155) of RR-TB patients. The diagnostic delay and total delay in lower health facilities was significantly higher than that in higher-levels (P < 0.05).

CONCLUSIONS

This study visualizes RR-TB healthcare-seeking flows in economically underdeveloped areas of China. Though healthcare access is decent, diagnostic delays are notable, especially at under-resourced facilities. We should pay more attention to and enhance the RR-TB diagnostic capabilities of primary health facilities. While treatment pathways are simple, financial burdens might be a key issue. Reducing these burdens through multi-channel funding and policy support is essential.