Investigation of Health Services for TB by External Private Providers (INSTEP) - Standardized Patient Study

Summary:  View help for Summary Privately practicing physicians have been associated with a lower quality of tuberculosis care. This study aimed to evaluate the correctness of private practitioners’ clinical decisions by using standardized tuberculosis cases posing as mystery patients. We developed four standardized tuberculosis cases, namely: (A) patient with classical tuberculosis-associated complaints, (B) case (A) presenting a negative microscopy result, (C) case (A) presenting a positive microscopy result, and (D) case (A) with a recent history of defaulting from a tuberculosis treatment. Professional actors presented these cases to randomly selected physicians and community health centers/puskesmas (cases A and D only) in Bandung, Indonesia, and recorded their interactions on a standardized self-report checklist. For each case, correct decision was defined as: (1) a referral for sputum examination, (2) a referral for a chest x-ray and/or prescription of non-anti tuberculosis drugs antibiotics, (3) prescription of anti-tuberculosis drugs, and (4) a referral for rapid molecular examination, respectively.