Family physicians managing tuberculosis. Qualitative study of overcoming barriers.

摘要

OBJECTIVE: To identify the types of non-clinical barriers family physicians face in the management of TB, and to suggest strategies for overcoming these barriers. DESIGN: Qualitative study based on focus group discussions with family physicians and specialists in different types of practices. SETTING: Private practices, community health centres, and family practice units in hospitals. PARTICIPANTS: Family physicians and specialists working in different practice settings. METHOD: At least one specialist participated in each focus group in order to understand possible differences in non-clinical barriers to TB management between family physicians and specialists. MAIN FINDINGS: Physicians can identify many types of non-clinical obstacles to TB management. Some obstacles appear to be directly related to the organization of family practice medicine, while others stem from the type of patient population seen or the stigma associated with TB. Some physicians question whether or not patient "noncompliance" is in fact a barrier to TB management. Many family physicians believe that they have readily available to them the expert opinion needed to manage TB effectively. CONCLUSIONS: Some specific interventions, such as changes in TB guidelines, could overcome some of the obstacles identified. Differences among family physicians in the organization and nature of their practice, and in their understanding of their role in TB management, however, should be taken into account in developing interventions because such differences could influence both the need for, and receptivity to, any changes.