Tuberculosis Case Notification by Registered Private Medical Practitioners in Kolkata: A Mixed-Methods Study

Background: Under?notification of tuberculosis(TB) cases remains a persistent problem that impedes accurate estimation of the disease burden. India’s private health sector contributes to only one?fourth of the total TB notifications. Objectives: The present study was conducted among registered private practitioners in Kolkata to assess their knowledge, attitude and practice on TB notification, to find the socio?demographic and work-related factors associated with it, to identify the barriers faced by them in notifying TB cases and to elicit suggested solutions in overcoming these barriers. Materials and Methods: It was an observational study, cross-sectional in design following explanatory sequential mixed?methods approach conducted among 426 private practitioners in Kolkata Municipal Corporation area over 2 years (July 2019–October 2021). Quantitative data were analyzed using SPSS 25.0 with suitable descriptive and inferential statistics. Qualitative data were analyzed using Atlas.ti 7.1 and data were represented in the form of themes, codes, and verbatims. Results: Out of 426, 295 (69.2%) of the study population had adequate knowledge, 385 (90.4%) had positive attitude and only 115 (27.0%) had satisfactory practice. Lack of awareness, inadequate communication, and breaching patient confidentiality were the main barriers identified. Suggested solutions to improve engagement of private sector were organizing more continuing medical educations, active case finding, and acknowledgement to private practitioners on notification. Conclusion: Private practitioners had adequate knowledge on TB notification, their attitude was very positive but practice was poor. Training and sensitization of private practitioners on notification are recommended with feedback from both ends.

A comparative study to assess prescription pattern, cost, and appropriateness of antimicrobial usage in a rural government tertiary care hospital and rural private practitioners

Background: Antimicrobial resistance is defined as the ability of microorganism (bacteria, fungus, virus, or parasite) to resist the effects of a drug to inhibit microorganism growth, which is becoming a major concern worldwide particularly in developing country like India. Aim and Objectives: The aim of this study was to identify, compare, and assess the appropriateness of antimicrobials prescribed in a rural tertiary care hospital and those prescribed by rural private practitioners and to assess the average cost of antimicrobials per prescription. Materials and Methods: A cross-sectional study was conducted, in which a total of 2003 prescriptions were analyzed from outpatient department (OPD) of rural tertiary and prescriptions from nearby chemist shops for prescription pattern, cost, and appropriateness. Results: It was identified that most of the antimicrobial containing prescriptions in both private and public health sector were prescribed by MBBS doctors (56.33%). In Government Medical College (GMC) OPDs, antimicrobials were prescribed mostly for gastrointestinal infection (25.75%) and beta lactams (45.23%) followed by fluoroquinolones (27.10%) were the most commonly prescribed. While among rural private practitioners, gastrointestinal infections (33.50%) followed by fever (27.70%) were the most common clinical conditions, for which antimicrobials were prescribed and 13.40% prescriptions contained more than one antimicrobial. About 43.37% of antimicrobials prescribed in OPDs of GMC and 56.20% antimicrobials prescribed by private practitioners were found to be inappropriate which was statistically significant. Conclusion: The study concluded that around half of the prescriptions analyzed were inappropriate and so there is a strict need of supervising the antimicrobials prescribing patterns, consumption, and it’s dispensing from the pharmacy shops.

A study to assess anxiety, stress and depression among private medical practitioners during COVID-19 pandemic: An observational study

Objectives: This study aims to assess the magnitude of anxiety, stress, and depression among private practitioners during the COVID pandemic 2020. Materials and Methods: A descriptive, observational and cross-sectional study was done using a semi-structured questionnaire through electronic media in the form of Google Forms. Patient health questionnaire 4 (PHQ4) and Perceived Stress Scale-10 were incorporated into the questionnaire to assess the psychological status in November 2020. Results: A total of 157 private practitioners participated in the study. Males constituted 60%. Participants have mean age (SD) of 44.2 (6.9) years with work experience and a mean (SD) of 16.3 (6.78) years. The anxiety and depression subscales of the PHQ-4 scale showed that 54.7% of the private practitioners have anxiety subscale ?3 and 28% have depression subscale >3 needing further psychiatric evaluation. Significant predictors of anxiety and depression were female gender, younger and less experienced, and those providing inpatient services in COVID care isolation facilities. Conclusion: There is a high prevalence of anxiety, stress, and depression among private practitioners comparable with other countries.

A Mixed Method Study to Assess Notification of Tuberculosis Patients by Private Practitioners in New Delhi, India

Background: A staggering one million tuberculosis (TB) cases are missing from notification, most of them being diagnosed and treated in the private sector. To curb this issue, the Government of India declared TB as a notifiable disease and NIKSHAY was launched in 2012. However, even after years of implementation, as per the report published by TB India 2020, the proportion of private case notification of total TB cases is very low. Objectives: The objectives of the study were to assess the current practices related to TB Notification being followed by private practitioners of Delhi and to explore the enablers and barriers to TB notification among private‑sector treatment providers. Methods: This cross‑sectional study was done from January 2019 to January 2020. Six hundred doctors were line listed under the chosen TB unit, 375 gave consent and in depth interview was conducted among them. Data were collected on the reporting status and facilitators and barrier toward NIKSHAY reporting were assessed. For the qualitative component, focused group discussions were done. Results: Out of 375 private practitioners, over two‑third (68%) practitioners reported that they were not treating TB patients. Out of 108 doctors treating patients only 50% were reporting the cases. Major reason cited for not reporting was “don’t know how to” and major barrier considered was “lack of training.” Conclusion: Strategies such as training and retraining, and one‑to‑one sensitization of private practitioners to address barriers may enhance TB notification.

Awareness and willingness to recommend HIV pre-exposure prophylaxis among private practitioners of Central Karnataka, India

Background: HIV continues to be a major public health problem. Single daily oral dose in formulation containing tenofovir and emtricitabine is approved for HIV-negative people who are at high risk of acquiring HIV. Since pre-exposure prophylaxis (PrEP) does not prevent other sexually transmitted infections and is not a contraceptive, it should not replace with other well-established HIV prevention interventions. Objective: The objective of this study was as follows: (i) Awareness toward HIV PrEP among private practitioners and (ii) willingness to recommend HIV PrEP to the people at risk of HIV. Materials and Methods: It is a cross-sectional study. This study was conducted among 100 private practitioners of Davangere city. Results: In the present study, 63% of private practitioners were correctly knowing the drugs used in HIV PrEP. About 3% and 13% of practitioners knew the contraindications and side effects of HIV PrEP, respectively. About 17% of practitioners correctly knew efficacy of HIV PrEP. About 83% of practitioners opine PrEP would not have impact on ART drug resistance. All study participants felt that HIV PrEP should be made available to target group at risk of HIV. The knowledge score was poor among 27% of private practitioners. Knowledge score was good among 23% of practitioners. The attitude score was poor among 13% of practitioners and it was good among 64% of practitioners. All the study participants were willing to recommend PrEP to at least one of the at-risk populations. Private practitioners were most willing to recommend PrEP to men who have sex with men (76%) and serodiscordant couples (60%). Conclusions: In the present study, although over two-third of health-care providers scored average to good in knowledge related to HIV PrEP, they were less aware of eligibility criteria, contraindications, side effects, and efficacy of PrEP. Most of the respondents had favorable attitude about HIV PrEP. Almost all participants were willing to prescribe PrEP to at least one of the risk populations and were more willing prescribe to serodiscordant couples and men who have sex men.

Evaluation of prescribing indicators in prescriptions of private practitioners in Kolkata, India.

Background: To assess the prescribing indicators in prescriptions of private practitioners in Kolkata. Methods: In the observational, retrospective, cross-sectional survey, 1830 prescriptions of private practitioners were collected over a 5 years period and assessed using core prescribing indicators as per the World Health Organization “How to investigate drug use in health facilities” tool. Results: Overall the average number of drug per prescription was 3.05±0.91. No drug was prescribed by generic name. Prescriptions with an antibiotics and injections were 30% (549/1830) and 8.12% (149/1830), respectively. Drugs prescribed from essential drug list (EDL) were 29.38% (1640/5582). Conclusion: Poly-pharmacy, lack of generic prescribing, low rate of prescriptions from EDL is the present prescribing scenario of private set-up based practitioners of Kolkata. Regulation and intervention is required to improve the irrational prescribing practices.

Insights into Ergonomics Among Dental Professionals of a Dental Institute and Private Practitioners in Hubli-Dharwad Twin Cities, India

BACKGROUND: To assess the knowledge, attitude, and practice of ergonomics among dental professionals of Hubli-Dharwad twin cities, India. METHODS: Investigator-developed, self-administered, closed-ended questionnaire assessing knowledge, attitude, and practices regarding ergonomics during dental practice was filled in by undergraduates, house surgeons, postgraduates, and faculty members of dental institutions and private practitioners from Hubli-Dharwad twin cities. RESULTS: Data were collected from a total of 250 participants, 50 belonging to each academic group. Overall mean knowledge, attitude, and practice scores were 52%, 75%, and 55%, respectively. Significant correlation was found for age with attitude (chi2 = 10.734, p = 0.030) and behavior (chi2 = 12.984, p = 0.011). Marital status was significantly associated with all the three domains; knowledge (chi2 = 29.369, p = 0.000), attitude (chi2 = 29.023, p = 0.000), and practices (chi2 = 13.648, p = 0.009). CONCLUSION: Participants had considerable awareness and behavior toward ergonomics in dental practice. The high attitude score indicates stronger acceptance of ergonomics principles and guidelines during routine dental procedures. The current study highlights the situation of ergonomics in dental practice in the form of knowledge, attitude, and practices.

Tuberculosis prescription practices in private and public sector in India.

Introduction: India has the highest burden of tuberculosis in world, accounting for 20% of global incidence of TB (Tuberculosis). TB treatment is available both in private and public sector in India. Aim & objectives: The current study was carried out to study and compare the prescribing practices of anti-tuberculosis medications by private practitioners and healthcare providers in public sector (under RNTCP-Revised National Tuberculosis Control Programme). Material and Methods: 105 anti TB prescriptions of private practitioners and 105 RNTCP (Revised National Tuberculosis Programme) treatment cards were analysed. Results: 9.52% prescriptions by private practitioners and 4.76 % RNTCP prescriptions were correct. Factors for drug resistance were present in 67.62 % of prescriptions by private practitioners and 28.57 % of RNTCP prescriptions whereas overdosing was present in 53.33 % of prescriptions by private practitioners and 68.57 % of RNTCP prescriptions. Conclusion: The anti TB treatment offered in private and public sector in India is not satisfactory at present and needs to be improved.

Involvement of Non-allopathic Private Practitioners under DOTS in an urban area of north India.

Background: In an urban area of a north Indian district (population 150,000), nine private practitioners of non-allopathic medicine, including five with no qualification and two private paramedical staff, were trained as per programme guidelines before being involved as treatment observers in the DOTS-based Revised National TB Control Programme and supervised. They were not given any financial incentive. Material and Methods: During 2002, they managed 185 TB patients (85% of the cases in the urban area) and amongst the 63 new smear-positive patients, the cure rate was 84%. Over a 6 month period, 6% of the total new smear-positive patients detected in the area were referred by these private practitioners. Results: Results suggest that non-allopathic practitioners and paramedical staff from the private sector can make a significant contribution to TB control, by increasing case detection and treatment observation.

Cancer control in the Philippines: The role of the private practitioners and surgeons

1. In this paper I have presented the cancer-control plan in America, together with a list of successful treatments by American surgeons and radiologists, for the purpose of achieving as many cases of five-year cures as possible. The cancerologists of America are convinced that cure in cancer by surgeons and radiologists can not be attained without a well organized control plan, in towns and countries consisting of early diagnosis and prevention, so that the slogan in cancer control should be: "Cancer is curable, provided it is diagnosed and treated early."2. I have pointed out to you that cancer control in the Philippines consists only of cancer cure and that we do not have the most important implement - namely, the systematic organization for cancer diagnosis and prevention in the provinces. Although the agencies of provincial hospitals and laboratories could be used, there is lack of cancer clinics from which cancer-consciousness among private practitioners and among the people could be disseminated3. As there are many advanced cancers not detected in the early stage, the surgeons of our country are not given the opportunity to achieve a large number of five-year cures through operation and irradiation; and the majority of the advanced cases operated on and irradiated recur, metastasize, and die within five years4. There is a large number of advanced cancers that are over-crowding the general hospitals of the provinces and cities, especially Manila. This is a problem in accommodation. It is also the cancer control problem of the medical profession of the Philippines in general and of the College of Surgeons in particular, because the surgeons of our country are adversely affected by the successful results of their operations in cancer. (Summary)