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It was experimental that 71% doctor does not ensure to take body weight, 66% of doctor does not to patients’ complains of sickness appropriately, 78% doctor does not have interest to inquire past disease history, 97% does not want to question patients’ socio-economic situations, 95% patient does not have interest to take history of drug allergy. Very oblivious attitude to patients were exposed and non-professionalism of doctors’ approach were exposed.
The number of drugs per prescription were taken consideration by totaling the cases that has received no drug, some has received one drug, some has received two drugs, some has received three drugs, some has received four drugs and some has received five drugs.
Progress was perceived after involvement. Usage of ‘no drug’ and ‘one drug’ was augmented in a substantial manner. The use of ‘two drugs’ was continued nearly the same. Whereas the usage of four and five drugs was lessened significantly. It is a worthy indicator of the accomplishment of the intervention programs. In public divisions, before encounter 6458 drugs was given and after counter 4913 drugs was prescribed.
In contrast, in private hospitals 10, 213 drugs were given before encounter and 9663 drugs were prescribed after counter.
After encounter, the measure of prescribed drugs was concentrated to 24% after intervention and only 6% was reduced in private sectors. The decreased tendency is greater in public hospitals compared to private. Globally, consultation time of patient is an argument considering to doctor patient interaction. Consultation time , a vital element is used for appropriate management. In most cases, patient consultation period was within 30 to 95 seconds though 45 to 100 seconds is the time range in private sectors that is greater than public sectors however not suitable.
Consultation span often differs from one region to another and is indomitable by equally patient’s and doctor’s individualities and time ranges remain between 10 to 15 minutes [511, 512]. Generally, studies have proven that patients desire elongated consultations. Doctors with elongated consultations incline to prescribe a smaller amount and suggest further instruction on lifestyle and additional health-promoting deeds. Typical consultation span varied across the world, extending from 48s that is in Bangladesh to 22.5min that is happened in Sweden. Eighteen countries demonstrating around 50% of the worldwide population expend 5min or less with their physicians of primary care. [513, 514, 515, 516 ].
Prescribing practice of TB presented a further unchanging pattern than prescribing pattern of ARI. All public hospitals ensured the Tb treatment practice suggested by WHO in Bangladesh . However in private hospitals, private consultants did not ensure any treatment practice suggested by WHO and STREAM. The Bangladesh regime is a recently established short course of 9 month treatment, for the cure of ‘uncomplicated MDR TB’. ‘MDR TB that is uncomplicated’ is TB where resistant are seen against the bacteria and rifampicin and isoniazid are the first line drugs. The typical cure that is for multi-drug resistant TB needs the usage of TB drugs that is’reserve’ or second line and the drugs need to take for 24 months. The study of STREAM (Standardized Treatment Regimen of Anti-Tuberculosis Drugs for Patients of MDR TB) is an current study buttressed by USAID.
In private hospitals, it was perceived that private practitioner did not follow any conventional drug regiment that is used for TB treatment. Private TB drug are prescribed and at least 3 to 4 anti-tuberculosis drug was given together, dosage regime was not correctly pursued and this convey to resistant against multiple drug very simply. In Bangladesh finding for the conformation of TB is poorly expedited, around 88% prescription encompassed diagnostic history and 78% prescription had beyond 4 diagnostic tests. On the contrary, in private sector 100% prescription encompasses history of diagnosis and 92% prescription encompassed exceeding 4 diagnostic tests. As Tb is a m greater for treating the disease, 3470 BDT was required that includes diagnostic tests in private hospitals for each prescription.
Nevertheless in public hospitals , TB drugs are completely free. Merely non TB drug expenses was 227 BDT for treating the co-existing disease. TB patient are collected as less than 4 years, 4 to18 years, 18 to 35 years and higher than 18 years. In cooperation with public and private sectors, 32% and 33% of the total patients are lower than 4 years of age, and the percentage of the patients are higher than of age range of 35 years are furthermost lying to TB. Age from 4 to 18 years in both public hospitals and private hospitals are completely low that is 18% and 22% correspondingly. In the same way, age from 18 to 35 years in public sector suffering from TB is 15% which is lower compared to the private sectors that have 22% TB patients.
In public hospitals, typical figure of anti-tuberculosis antibiotic was 3.7 before interference and after intervention, 2.85 was for the TB patient year lesser compared to 4. Same figure of drugs are also prescribed as 3.55 and 3.43 before and after intervention by private sectors. Patient pleasure level in public sectors was greater (50% little satisfied)compared to private sectors (25%). Private healthcare sector has abundant potential of supportive tuberculosis control. Gender and age had life-threatening implications. With the increasing migration moves from tuberculosis-endemic African countries, clinicians in central and northern Europe may be further often threatened with atypical difficult patterns of osteoarticular tuberculosis [517, 518, 519, 520].
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