International Standards of

1. International Standards of Tuberculosis Care Implementation by Pulmonologists in Private Practice in Jakarta E. Burhan1, M. A. Nawas1, D. Kusumo Sutoyo2, F. Yunus1, L. Chen3, B. M. Djojonegoro3, P. C. Hopewell3, F. Mulyani4, D. E. Mustikawati5 1The Indonesian Society of Respirology, Jakarta, Indonesia; 2Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; 3American Thoracic Society, New York, New York, and Curry International Tuberculosis Center, UCSF, Oakland, USA; 4DKI Jakarta Provincial Health Office, Jakarta, Indonesia; 5Subdirectorate of Tuberculosis Control, Ministry of Health, Jakarta, Indonesia Background: Most pulmonologists in Jakarta practice in private hospitals and treat tuberculosis (TB) patients. With the introduction of the International Standards of Care (ISTC) and DOTS, pulmonologists are expected to implement the standards in their practice regardless of limitations in their private practice settings. To improve case notification and monitoring of treatment outcomes, the Indonesian Society of Respirology (PDPI) implemented a project in which selected private pulmonologists agreed to manage patients in accordance with the ISTC and National TB Program (NTP) guidelines. Methods:  To validate information from TB case reporting through the PDPI project, we reviewed medical records from the practices of 21 pulmonologists from 16 private hospitals in East, South, and Central Jakarta. Abstractors with TB clinical background collected data from 258 TB patients, diagnosed between October-December 2010, with expected treatment completion by June 2011. We developed a questionnaire and scoring system related to diagnosis, therapy, monitoring, and outcomes of TB treatment to assess ISTC implementation. Excerpt of Abstraction Tool Standards and Their Implementation Result: We evaluated 11 of 21 standards: 4 diagnostic, 5 treatment, 1 co-morbidity, and 1 public health standards. Four pulmonologists (19%) adhered to all standards, 8 (38%) adhered to 10 of 11 standards, 1 met only 8 of 12 standards, while the rest met varied numbers of standards. Standard 21 is implemented by all pulmonologists and Standards 4 and 8 are implemented well by >80% of pulmonologists. Standard 11 was least implemented, with no or partial implementation by 90% of pulmonologists. Of 258 TB cases, 65% were successfully treated, 1% failed, 1% died, 28% defaulted from treatment, and 5% transferred out to another facility. Patient Outcome *Percent of pulmonologists who implemented the standard for >=50% of their patients Discussion:Most of the pulmonologists performed appropriate ISTC implementation in their private practice. The high number of patients who defaulted from treatment may indicate the lack of patient education given by pulmonologists or the need of a better linkage system among private providers and the local Health Office to ensure continued TB treatment of patients.