Use of standardised patients to assess quality of tuberculosis care : a pilot, cross-sectional study
A standardised patient is an individual trained to act as a real patient in order to simulate a set of symptoms or problems
Abstract
Background
Existing studies on quality of tuberculosis care mostly reflect knowledge, not actual practice.
Methods
We conducted a validation study on the use of standardized patients (SPs) for assessing quality of TB care. 4 cases, 2 for presumed TB and one each for confirmed TB and suspected MDR-TB, were presented by 17 SPs, with 250 SP interactions among 100 consenting providers in Delhi, including qualified (29%), alternative medicine (40%) and informal providers (31%). Validation criteria were: (1) negligible risk and ability to avoid adverse events for providers and SPs; (2) low detection rates of SPs by providers, and (3) data accuracy across SPs and audio verification of SP recall. We used medical vignettes to assess provider knowledge for presumed TB. Correct case management was benchmarked using Standards for TB Care in India (STCI).
Findings
SPs were deployed with low detection rates (4.7% of 232 interactions), high correlation of recall with audio recordings (r=0.63; 95% CI: 0.53 – 0.79), and no safety concerns. Average consultation length was 6 minutes with 6.2 questions/exams completed, representing 35% (95% confidence interval [CI]: 33%–38%) of essential checklist items. Across all cases, only 52 of 250 (21%; 95% CI: 16%–26%) were correctly managed. Correct management was higher among MBBS doctors (adjusted OR=2.41, 95% CI: 1.17–4.93) as compared to all others. Provider knowledge in the vignettes was markedly more consistent with STCI than their practice.
Interpretation
The SP methodology can be successfully implemented to assess TB care. Our data suggest a big gap between provider knowledge and practice.
This research was supported by the UK Department for International Development’s Operational Research Capacity Building Programme led by the International Union Against TB and Lung Disease (The Union)
Citation
Jishnu Das, Ada Kwan, Ben Daniels, Srinath Satyanarayana, Ramnath Subbaraman, Sofi Bergkvist, Ranendra K. Das, Veena Das, Madhukar Pai, (2015) Use of standardised patients to assess quality of tuberculosis care : a pilot, cross-sectional study. Lancet Infectious Diseases 2015 November; 15(11): 1305–1313. doi:10.1016/S1473-3099(15)00077-8.
Links
Use of standardised patients to assess quality of tuberculosis care : a pilot, cross-sectional study