Use of standardised patients to assess gender differences in quality of tuberculosis care in urban India: a two-city, cross-sectional study

Summary: Background: In India, men are more likely than women to have active tuberculosis but are less likely to be diagnosed and notified to national tuberculosis programmes. We used data from standardised patient visits to assess whether these gender differences occur because of provider practice...

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Main Authors: Benjamin Daniels, MSc, Ada Kwan, MHS, Srinath Satyanarayana, MD, Ramnath Subbaraman, MD, Ranendra K Das, PhD, Veena Das, ProfPhD, Jishnu Das, PhD, Madhukar Pai, ProfMD
Format: Article
Language:English
Published: Elsevier 2019-05-01
Series:The Lancet Global Health
Online Access:http://www.sciencedirect.com/science/article/pii/S2214109X19300312
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spelling doaj-e2a0de60a69f4d5ca758d3764be6385d2020-11-25T02:00:24ZengElsevierThe Lancet Global Health2214-109X2019-05-0175e633e643Use of standardised patients to assess gender differences in quality of tuberculosis care in urban India: a two-city, cross-sectional studyBenjamin Daniels, MSc0Ada Kwan, MHS1Srinath Satyanarayana, MD2Ramnath Subbaraman, MD3Ranendra K Das, PhD4Veena Das, ProfPhD5Jishnu Das, PhD6Madhukar Pai, ProfMD7Development Research Group, The World Bank, Washington, DC, USADevelopment Research Group, The World Bank, Washington, DC, USA; University of California at Berkeley, Berkeley, CA, USACenter for Operational Research, International Union Against TB and Lung Diseases, Paris, FranceDepartment of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USAInstitute for Socio-Economic Research on Development and Democracy, Delhi, IndiaDepartment of Anthropology, Johns Hopkins University, Baltimore, MD, USADevelopment Research Group, The World Bank, Washington, DC, USA; Center for Policy Research, New Delhi, IndiaMcGill International TB Centre and Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada; Manipal McGill Centre for Infectious Diseases, Manipal Academy of Higher Education, Manipal, India; Correspondence to: Prof Madhukar Pai, Department of Epidemiology and Biostatistics, McGill University, Montreal, QC H3A 1A2, CanadaSummary: Background: In India, men are more likely than women to have active tuberculosis but are less likely to be diagnosed and notified to national tuberculosis programmes. We used data from standardised patient visits to assess whether these gender differences occur because of provider practice. Methods: We sent standardised patients (people recruited from local populations and trained to portray a scripted medical condition to health-care providers) to present four tuberculosis case scenarios to private health-care providers in the cities of Mumbai and Patna. Sampling and weighting allowed for city representative interpretation. Because standardised patients were assigned to providers by a field team blinded to this study, we did balance and placebo regression tests to confirm standardised patients were assigned by gender as good as randomly. Then, by use of linear and logistic regression, we assessed correct case management, our primary outcome, and other dimensions of care by standardised patient gender. Findings: Between Nov 21, 2014, and Aug 21, 2015, 2602 clinical interactions at 1203 private facilities were completed by 24 standardised patients (16 men, eight women). We found standardised patients were assigned to providers as good as randomly. We found no differences in correct management by patient gender (odds ratio 1·05; 95% CI 0·76–1·45; p=0·77) and no differences across gender within any case scenario, setting, provider gender, or provider qualification. Interpretation: Systematic differences in quality of care are unlikely to be a cause of the observed under-representation of men in tuberculosis notifications in the private sector in urban India. Funding: Grand Challenges Canada, Bill & Melinda Gates Foundation, World Bank Knowledge for Change Program.http://www.sciencedirect.com/science/article/pii/S2214109X19300312
collection DOAJ
language English
format Article
sources DOAJ
author Benjamin Daniels, MSc
Ada Kwan, MHS
Srinath Satyanarayana, MD
Ramnath Subbaraman, MD
Ranendra K Das, PhD
Veena Das, ProfPhD
Jishnu Das, PhD
Madhukar Pai, ProfMD
spellingShingle Benjamin Daniels, MSc
Ada Kwan, MHS
Srinath Satyanarayana, MD
Ramnath Subbaraman, MD
Ranendra K Das, PhD
Veena Das, ProfPhD
Jishnu Das, PhD
Madhukar Pai, ProfMD
Use of standardised patients to assess gender differences in quality of tuberculosis care in urban India: a two-city, cross-sectional study
The Lancet Global Health
author_facet Benjamin Daniels, MSc
Ada Kwan, MHS
Srinath Satyanarayana, MD
Ramnath Subbaraman, MD
Ranendra K Das, PhD
Veena Das, ProfPhD
Jishnu Das, PhD
Madhukar Pai, ProfMD
author_sort Benjamin Daniels, MSc
title Use of standardised patients to assess gender differences in quality of tuberculosis care in urban India: a two-city, cross-sectional study
title_short Use of standardised patients to assess gender differences in quality of tuberculosis care in urban India: a two-city, cross-sectional study
title_full Use of standardised patients to assess gender differences in quality of tuberculosis care in urban India: a two-city, cross-sectional study
title_fullStr Use of standardised patients to assess gender differences in quality of tuberculosis care in urban India: a two-city, cross-sectional study
title_full_unstemmed Use of standardised patients to assess gender differences in quality of tuberculosis care in urban India: a two-city, cross-sectional study
title_sort use of standardised patients to assess gender differences in quality of tuberculosis care in urban india: a two-city, cross-sectional study
publisher Elsevier
series The Lancet Global Health
issn 2214-109X
publishDate 2019-05-01
description Summary: Background: In India, men are more likely than women to have active tuberculosis but are less likely to be diagnosed and notified to national tuberculosis programmes. We used data from standardised patient visits to assess whether these gender differences occur because of provider practice. Methods: We sent standardised patients (people recruited from local populations and trained to portray a scripted medical condition to health-care providers) to present four tuberculosis case scenarios to private health-care providers in the cities of Mumbai and Patna. Sampling and weighting allowed for city representative interpretation. Because standardised patients were assigned to providers by a field team blinded to this study, we did balance and placebo regression tests to confirm standardised patients were assigned by gender as good as randomly. Then, by use of linear and logistic regression, we assessed correct case management, our primary outcome, and other dimensions of care by standardised patient gender. Findings: Between Nov 21, 2014, and Aug 21, 2015, 2602 clinical interactions at 1203 private facilities were completed by 24 standardised patients (16 men, eight women). We found standardised patients were assigned to providers as good as randomly. We found no differences in correct management by patient gender (odds ratio 1·05; 95% CI 0·76–1·45; p=0·77) and no differences across gender within any case scenario, setting, provider gender, or provider qualification. Interpretation: Systematic differences in quality of care are unlikely to be a cause of the observed under-representation of men in tuberculosis notifications in the private sector in urban India. Funding: Grand Challenges Canada, Bill & Melinda Gates Foundation, World Bank Knowledge for Change Program.
url http://www.sciencedirect.com/science/article/pii/S2214109X19300312
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