Patient and health care system delays in Queensland tuberculosis patients,1985-1998

SETTING: Queensland tuberculosis (TB) control centre (QTCC). OBJECTIVE: To investigate patient and health care system delays in the diag nosis of active TB in Queensland. DESIGN: Analysis of data extracted from the QTCC database and review of cha rts. Symptomatic patients with bacteriologically or histologically proven T B were considered as a total group and a pulmonary smear-positive (PSP)grou p. RESULTS: The median patient delays were 29 days (total group) and 30 days ( PSP group). The median health care system delays were 22 days (total group) and I I days (PSP group). There were significant trends towards increasing health care system delays with increasing age and longer residency of migr ants in Australia. Health care system delays were significantly longer for females and those aged over 45. Migrants from countries of high TB incidenc e and indigenous Australians had shorter health care system delays compared to non-indigenous Australians. Common reasons for diagnostic delays of mor e than 90 days were failure to perform appropriate investigations and misdi agnosis of chest X-rays. CONCLUSION: Physicians need to consider including TB in the differential di agnosis in older age groups and migrants with longer residency in Australia . There should be a low threshold for obtaining chest X-rays and sputum sam ples in patients with persistent cough.