Application or Proposal

OPERATIONS RESEARCH COMMITTEE
STATE TASK FORCE, RNTCP- [Jharkhand State]

FORMAT FOR PROPOSAL SUBMISSION
Year and month of submission: September 2016
Section A: GENERAL
(Please read the prospectus and section 6 of this format carefully before filling the format)
1. Title of the Research Proposed:
Assessment of the physical barriers faced by PLHAs (on ART) of Dhanbad , Jharkhand in
accessing TB care
2. Investigators (Name; Designation)
i. Principal Investigator: Dr (Prof) Arun kumar
Dr Matin Ahmad Khan
.
ii. Co-investigator(s): , Dr.Rabi Bhushan, Dr C.S.Suman, Dr.Bipin kr .sinha, Dr.Avinash kumar ,.
Dr. A.K. Bishwas ,Dr.B.K. Singh
.
.
.
3. Institution
Name: PATLIPUTRA MEDICAL COLLEGE ,
Jamshedpur
Postal address: SARAIDHELA , DHANBAD,826005
Jharkhand
Email address: principalpmc@gmail.com
Telephone/Fax No: 0326-2230465..
4. Duration of Research work
Total Duration(in months):6 months
Period of data collection: Oct 2016/Nov 2016.. (MM/YY)
Period of data analysis: Dec 2016/Mar 2017.. (MM/YY)
Expected month of submission of findings to state OR committee as a report oras an article to a
journal: APR 2017 / May 2017 .... (MM/YY)
5. Total amount of grant-in-aid asked for (in Indian Rupees; details are to be
furnished in section B): 75,000INR
(In words)Seventy Five Thousand only
..
6. Declaration and attestation:
a. I/We agree to submit the findings of the OR to the state OR committee as a scientific report and
power-point presentation irrespective of whether or notit is submitted as an article to a journal; in
the immediate CC/STF meeting
b. I/we agree to submit Statement of expenditure duly attested a competent authority of the institute
within one month of submission of report as mentioned in clause (a)
Signature of the :
1) Principal Investigator Dr (Prof) Arun kumar
Dr Matin Ahmad Khan
Co-Investigator(s) Dr.Rabi Bhushan, Dr. A.K. Bishwas, Dr C.S.Suman,
Dr.Avinash kumar ,. ,Dr.B.K. Singh
2) Head of the Department (if any) Dr. (Prof) P. Singh
3) Head of the Institute (Principal) Dr ( Prof) Arun kumar
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Dr.Bipin kr .sinha,

rd
Dated (dd/mm/yyyy): 3 Sept 2016
Seal of the Institution:
PATLIPUTRA
RNTCP
MEDICAL COLLEGE, DHANBAD,
Page 2

Section B: DETAILS OF THE RESEARCH PROTOCOL
(Adequate information must be furnished in a brief but self-contained manner to enable the OR
Committee to assess the proposal)
1. Title of the Operations research proposed (100 characters maximum):
An assessment of the physical barriers faced by PLHAs of Dhanbad and Jamshedpur
Jharkhand in accessing TB treatment (a multi centric study)
Research Question What are the physical barriers faced by PLHAs (on ART) of Dhanbad
and Jamshedpur Jharkhand in accessing TB care ?
2. A brief write up on usefulness of the research and its application to RNTCP

(250 words maximum):
The interaction between HIV and TB in co-infected persons is bidirectional and synergistic and the
convergence of the tuberculosis (TB) and the HIV epidemics pose new public health challenges. TB
is the most common opportunistic infection seen in HIV patients. The lifetime risk of TB in immunecompetent persons is 5-10% whereas in an HIV-infected person, the annual risk of TB is 5-15% . Of
the 34 million people living with HIV in the world , an estimated 30% have concomitant (usually latent)
infection with M. Tuberculosis TB is the leading cause of death among PLHAs ( one in four HIVrelated deaths ) PLHAs are facing emerging threats of drug-resistant TB such as multi-drug
resistant (MDR-TB) and extensively drug resistant TB (XDR-TB). Malnutrition and low body mass
index (BMI < 17 ) are associated with an increased risk of mortality after antiretroviral therapy starts
of 26 times, irrespective of CD4 count.
India has the highest TB burden in the world and accounts for 23% of the global incidence of TB
Nearly 5% of the 2 million TB incident cases are HIV seropositive While the HIV epidemic in the
country is showing a declining trend with a 56% drop in the number of new infections from 1996 levels
,there are still an estimated 2.27 million HIV +and in Jharkhand the prevalence has in fact increased
from 0.13 in 2009 to 0.25 in 2013 as per NACO Phase III State Fact Sheets March 2013 despite
having well-structured and functional national programs for the control of both HIV and TB-- the NACP
and RNTCP respectively ,having well established cross-referral mechanisms . Little evidence is
available from India regarding the incidence and mortality due to TB among ART populations . In
East Singhbhum District the no of HIV + patients is around 1000 while the number HIV patients on
ART who were put on ATT in the last 2 years is more than 100 . TB and HIV co-infection are weak
coordination between TB and HIV programs and slow integration of collaborative TB-HIV services
into the general health services. There are economic , social , health facility barriers which may
have an adverse impact on patients treatment access and resulting into unfavorable outcomes .
PLHAs in India, face stigma and discrimination in a variety of contexts including household,
community, workplace & health care settings and act as barriers to seeking and receiving treatment
and care services. The attitude and behavior of health care providers influence --, the willingness and
ability of people with HIV to access care and the quality of care they receive.
Application to RNTCP
Very little research from India has characterized the burden of TB in HIVinfected persons Better
understanding of the characteristics and motivations of TB/HIV patients facing problems in taking
treatment , may help design interventions to correct this phenomena.
The knowledge of the health seeking behavior and reasons, particularly in HIV patients , will facilitate
development of adequate strategies and messages to modify their health seeking behavior in
removing stigma to increase access to TB/HIV care .
3. Present knowledge/literature on the subject(200 words maximum):
Tuberculosis (TB) and HIV infection are very closely linked, and over a million persons with both
conditions are estimated to need simultaneous treatment for both diseases each year. People living
with HIV (PLHAs) have an increased risk of becoming infected and developing TB. Although TB is
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curable, it is a leading cause of ill health and death among PLHs. For this reason, early diagnosis,
timely initiation of treatment for both diseases and careful monitoring are essential to treat TB in
PLHAs and identify HIV infection in people with TB The dual epidemics of tuberculosis (TB) and
human immunodeficiency virus (HIV) are closely related with each disease influencing the
epidemiology, natural history, clinical presentation and treatment outcomes of the other (CDC 1998).
HIV is fuelling the TB epidemic in many countries of the world, especially in sub-Saharan Africa and
increasingly in Asia and South America (WHO 2004). Similarly, TB is undermining the efforts of HIV
prevention and control programs in the developing countries by increasing morbidity and mortality in
people living with HIV/AIDS (Raviglione 1992). There exists a positive synergistic relationship
between HIV and TB infections. HIV is the most potent risk factor for reactivation of latent TB
infection, progression of new infection and re-infection to active TB disease and spread of drug
resistant TB strains in the community (Goldfeld and Ellner 2007). The life time risk of developing TB
in immune-competent individuals is 5% to 10% but in people living with HIV/AIDS the risk of
developing active TB disease is 60% (WHO 2003). HIV status also influences treatment outcomes in
TB patients. HIV positive individuals are at increased risk of developing drug resistant TB strains.
Similarly, TB accelerates the course of HIV disease by increasing HIV-RNA viral
loads in co-infected individuals (Garrait et al 1997). In fact, the onset of TB, often in a site outside the
lungs, could be the first indication of underlying HIV disease in people who are otherwise unaware of
their HIV status. TB is also the leading cause of mortality in HIV infected individuals.
Despite the fact that TB is curable and HIV is treatable, an estimated 8.5 million new and relapsed
TB cases were reported in 2010, and an estimated 1.4 million died, which included 350,000 people
living with HIV and co-infected with TB. The two diseases are closely linked because TB is frequently
the first opportunistic infection in people living with HIV (PLHIV) and is the leading cause of death
among them too, with one in four AIDS-related deaths caused by TB. Yet in 2010, only 34% of TB
patients (1.7 million) were screened for HIV, and only 5% of HIV patients were screened for TB
worldwide, while we know that The risk of developing TB increases in patients with HIV. The TB-HIV
co-epidemic is a major public health problem and is increasing cause of morbidity worldwide.
The 2007 survey conducted by NACO has produced the prevalence of HIV among TB patients
between 1% and 13.8%. A study from western India showed 57/64 HIV seropositive cases having
tuberculosis (TB) , while a study from South India has found ELISA HIV seropositivity in cases of
tuberculosis to the tune of 1.3% only.
The main obstacles to managing patients with TB and HIV co-infection are weak coordination
between TB and HIV programs and slow integration of collaborative TB-HIV services into the general
health services. These challenges may have an adverse impact on patients treatment access and
outcomes. The escalating human immunodeficiency virus (HIV) and tuberculosis (TB) epidemics have
a significant impact on public health services in resource-limited settings four potential barriers to
treatment use by comparing the reported perceptions and experiences of HIV-positive adults (age
18+) who have never taken a prescription medicine to treat their HIV (untreated patients) to those
who had begun taking a prescription medicine to treat their HIV in the past five years (treated
patients):
Limited disease-specific knowledge. Untreated patients are less knowledgeable about HIV and its
potential effects than treated patients. Only 38 percent of untreated patients believe that HIV attacks
the immune system and body even if the person with HIV does not feel sick, compared to 63 percent
of treated patients.
Thirty-nine percent of untreated patients believe the human body has a natural ability to fight HIV,
compared to 16 percent of treated patients.
Limited treatment-specific knowledge. Untreated patients also have limited treatment-specific
knowledge and cite reasons for not using HIV prescription medicine that are inconsistent with
available data or current treatment guidelines. Data show that HIV-positive patients who take HIV
prescription medicine reduce their risk of transmitting the virus to someone else by 96 percent , but
only 25 percent of untreated patients are aware being on a HIV prescription medicine reduces that
risk
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Despite its proven efficacy, only 28 percent of untreated patients believe that HIV prescription
medicine controls the negative effects of the disease
Misperceptions regarding treatment use. The reported perceptions of HIV prescription medicine
among untreated patients were somewhat negative and inconsistent with the reported experiences of
treated patients.
Nearly one-third (30 percent) of untreated patients believe that the side effects of HIV prescription
medicine are worse than HIV itself, but only 15 percent of treated patients report this to be the case
Eighty percent of treated patients believe that their HIV prescription medicine makes them feel better,
and they can focus on the important things in their life, and 56 percent say that it has had a positive
impact on their overall health and well-being. However, one in five (20 percent) of untreated patients
dont currently take HIV prescription medicine because they believe once they start, theyll need to be
on it for the rest of their lives
Fewer positive perceptions of overall well-being.
Untreated patients are less likely than treated patients to agree that their disease is well-controlled (84
percent vs. 91 percent) and less likely to agree they will live a full life despite their HIV (72 percent vs.
83 percent)
4. Objectives (4 maximum):
a) To find whether physical barriers affect TB Control activities
b) To know the % of the completed ATT among the referred patients
a) To assess the access of quality TB care for people living with HIV (PLHVs) by knowing the % of
referrals of ART Chest symptomatics and their cure rates .
b) To find whether HIV/AIDS related stigma effects TB control activities .
5. Methodology(250 words maximum):

a. Study design (cross-sectional, longitudinal etc.) : Observational (Retrospective )descriptive
study
Sampling (simple random, cluster etc.) All patients enrolled in TB/HIV care (Census)
b. Sample size (how arrived at) Target Population : All enrolled ART receiving Patients on Anti
tubercular (ATT) patients Study population : All ART receiving AIDS patients ( >18+ years of
age ) on / or completed /defaulted ATT in the last two years
c. Selection of Samples Study using the questionnaire which will contain questions about
problems faced by them during their visits to ART centre at PATLIPUTRA MEDICAL COLLEGE
DHANBAD Definitions, procedures, inclusion exclusion criteria if any: Descriptive statistics
like mean, range, frequency distributions and percentages will be used.
d. Inclusion criteria i) All enrolled and consenting TB/HIV patients aged > 18 years , on both
medicines for TB/HIV consenting to be part of study ii) AIDS patients on ART have completed
/not completed ATT in the last 2 years .
e. Variables Stigma and discrimination, attitude of health care givers will be the main outcome
(dependent variable) while demographic factors (age, sex, education socio-economic status)
will be the explanatory factors (independent variables).
f. Research tool : A structured questionnaire administered to ART-ATT receiving AIDS patients
Plan of analysis :. Myself (Dr Matin ) along with Dr.Rabi Bhushan, Dr C.S.Suman, Dr.Bipin kr .
sinha, Dr.Avinash kumar ,. Dr. A.K. Biswas , Dr.B.K. Singh , and other investigators will be
responsible for both the desk activities and work on the ground and 1 TB/HIV Coordinator and
Female ART Counselor will help us and complete the team.
The services of the Statistician from I .S. M Dhandad will be taken for statistical analysis.
g. Ethical aspects: In this study, the we shall see to it that ethical standards of research:
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protection of the rights of the participants and the institution; maintenance of scientific integrity of
the research and dissemination of the research findings are ensured .
h. The study involves human subjects as respondents thus the following will be done to protect
their rights as per ethical consideration
Informed consent
A written informed consent explaining the objectives, the benefits and potential risks of the study
will be obtained from each respondent. The respondents will be made to sign to the consent
only after voluntarily accepting to participate in the study.
Confidentiality and anonymity
To ensure confidentiality and anonymity, respondents will be assured that all their responses and
information obtained from them during the study will not be disclosed to anyone. There will be no
names required to be written All study materials like questionnaires will be free from personal
identifiers and no addresses of the respondents will be included on the data collection tools to
avoid any unfair treatment or possible exploitation of the respondent. For the purpose of
confidentiality, data will be coded with numbers instead of names.
Respect for human dignity
To ensure respect and dignity for the respondents, all respondents before signing the consent will
be briefed about the study objectives, their rights, the benefits and potential risks. Data collection
will be done in a socially conducive environment and secluded venue. The researchers will avoid
any form of coercion to force the respondents to participate and no rewards will be given to those
who accepted to participate in the study.
Right to withdraw from the study
In this study, the respondents will be informed of their right to withdraw from the study at any time
they wish so if they feel uncomfortable. They will also be assured that their withdrawal will not
affect their studies at A Grade Nursing School, PATLIPUTRA Medical College ,DHANBAD
Protecting the rights of the institutions
To conform to bioethical standards, approvals to carry out the study will be obtained from the
Ethical Committee PATLIPUTRA Medical College ,DHANBAD.
Scientific Integrity of the research
When carrying out the study, the researcher will avoid any form of plagiarism by ensuring that all
the sources of the scientific information that gets quoted in the study , will be acknowledged and
correctly referenced.
6. Budget: Submit the budget following a pattern as given below
(PS: It is not mandatory to follow the same heads while preparing the budget. However all heads
relevant for your study should be included as new rows, even if it is not mentioned in the template
below)
No.
No.
Cost Per
Total
Head
of
of
Remarks
day
Amount
Units Days
Honorarium of Investor(s)
No Investigator will
draw any
NA
honorarium from
the project .They
will work for free
Honorarium for field
300 Rs
2
25
15,000 Rs
investigator(s)
Travel Cost (if any)
To cover travel cost
25,000 Rs
25,000 Rs
of all investigators
and field staff
Lodging & Food cost (if any)
5,000 Rs
5,000 Rs
Data Entry cost
Includes covering
7000 Rs
7000 Rs
for the fee of
statistician
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Stationery
5000 Rs
5000 Rs
Miscellaneous (IEC Charges,
journal submission charges
15,000 Rs
15,000 Rs
etc if any)
SUB-TOTAL:
72,000 Rs
Over-Head Costs (Max 4% of
3,000 Rs
sub-Total
GRAND-TOTAL
75,000 Rs
In Words: ,,,,,Seventyfive Thousand only
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Section C: DETAILS OF THE INVESTIGATOR(S)
(Information submitted must be relevant to research and teaching experience only;submit Section C
separately for each investigator in case of more than oneinvestigator)
1. First Name: DR Arun Surname: Kumar
2. Designation with Department: Prof ,PSM
Principal ,PMC Dhanbad
3. Complete Postal Address with pincode: Patliputra Medical College ,Dhanbad ,826005
4. Email :principalpmc@gmail.com
5. Contact Numbers: 9471191666,

6. Educational qualification (Not to mention those below MBBS)
Degree
Institution
Year
MBBS
DMCH,Darbhanga
1978
M.D
PMCH,Patna
1985
Specify Subjects
Medical Subjects
P.S.M
.
7. Research or Training Experience (Do not include your Thesis, if any)
Srl.
Duration
Institution
Particulars
No.
1. Academic Councellor for PGDMCH Course,
Indira
Gandhi Open University.

2. R.C.H. Trainer from January 2000
3. Training of Childhood Psychiatric disorder.
4. Master trainer in Disability prevention and
rehabilitation.
5.Training in Educational Science and Technology in
1.
Medical Education.
6. Training on Acconutancy from State Institute of Rural
Development, Ranchi (SIRD)
7. RNTCP trainer from june 2004.
8. Trained for Management Development Programme on
Behavioural Skills for Senior Health Administrators.
.
8. Major areas of research interest/ area of specialisation:TB/HIV Care,Public Health.
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9. First Name: DR MATIN AHMAD Surname: KHAN
10. Designation with Department: Associate Prof Deptt of Biochemistry
11. Complete Postal Address with Pin code: Patliputra Medical College ,Dhanbad 826005
12. Email :mak5962@hotmail.com
13. Contact Numbers: 9431184120

Degree
Institution
Year
MBBS
PMCH , Dhanbad
1987
RMCH(RIMS) ,
DMRD
1993
Ranchi
School of Tropical
Fellowship in HIV
Medicine (STM) and
2007
Medicine
Medical College ,
Kolkata
.
Srl.
Duration
Institution
No.
1.
5 daysx2 =10 days
RNCTP
Specify Subjects
Medical Subjects
Radio-diagnosis
HIV Medicine
Particulars
RNTCP
.
16. Major areas of research interest/ area of specialisation: HIV Medicine , TB/HIV Care
17. Recent publications (last 5 publications only if any), you may also mention
papers currently in-press
Srl
.
Title of article/ chapter/
Peer Reviewed
Journal Name
No
publication
Journal? (Yes/No)
.
International Journal of Collaborative
Treatment of AIDS : A
Research on Internal Medicine &
1
Prevention Pill, March
Yes
Public Health Vol 3 No 2 2011 (ISSN
2011
I986-5872)
Blips and its clinical
2
relevance in HIV Patients
Yes
on Treatment, June 2012
I986-5872
3
A Pharmacogenomical
Yes
perspective in HIV/AIDS
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Therapies June 2012
I986-5872)
: Has a time to talk about
cure of AIDS arrived?
June 2012
I986-5872
Cure : Its meaning in the
JIMA Journal of Indian Medical
context of HIV/AIDS
Association
Yes
Yes
.
18. Recent conference paper/poster presentations (last 5 paper/poster presentations only if any)
Srl.
Title of paper/ poster
Name of the
Venue
Dated
No.
presentations
conference
A case scenario involving different AIDS Society of India
12-14th
1
Kolkata
modalities
(ASICON) 2014
Dec,2014
of HIV /AIDS and Treatment of
IMA Annual
2
Jamshedpur
March 2013
AIDS : A Prevention Pill
Conference
3
4
5
19. Give details of financial support received from other sources if any
N/.A
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20. First Name: Dr. Rabi Surname: Bhushan
21. Designation with Department: Tutor, PSM
22. Complete Postal Address with PINCODE:Patliputra Medical College ,dhanbad ,826005
23. Email : rbhushan07@gmail.com
24. Contact Numbers:, 9955206057

Degree
Institution
Year
Specify Subjects
MBBS
DMC,Darbhanga
2003
Medical Subjects
Dip-EPIDEMIOLOGY
IIPH,DELHI
2013
Epidemiology
MPH
G.O.U.
2016
Public Health
.
Srl.
Duration
Institution
Particulars
No.
1.
1 Week
Chandigarh
MASTER TRAINER:- ICD-X & ICF
1 Week
Lucknow
MASTER TRAINER:- RRT
1 Week
Bhuvaneshwar
TRAINING OF TRAINERS:- IDSP
.
27. Major areas of research interest/ area of specialisation :-Epidemiology, Public Health.
28. Recent publications (last 5 publications only if any), you may also mention
papers currently in-press
Srl
.
Title of article/ chapter/
Peer Reviewed
Journal Name
No
publication
Journal? (Yes/No)
.
1
2
3
4
5
.
Int J Tuberc Lung Dis. 2004 Dec;8(12):1479-83.
Access and adhering to tuberculosis treatment: barriers faced by

patients and communities in Burkina Faso.
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Sanou A1, Dembele M, Theobald S, Macq J.

Author information
Abstract
SETTING:
Three selected districts in Burkina Faso.
OBJECTIVES:
1) To explore patients' and community members' perceptions and problems associated with accessing formal
tuberculosis (TB) treatment; and 2) to identify patients' and community members' perceptions and problems
associated with adhering to formal TB treatment.
METHODS:
Twenty-eight focus group discussions and 68 in-depth interviews with TB patients, community representatives,
members of the health centre management committee, traditional healers and health professionals.
RESULTS:
Attending the health centre was the last resort for patients with symptoms indicative of TB. When on treatment,
patients faced a number of barriers in adhering to care. These related to the centralised nature of direct
observation and the problems faced whilst at the treatment unit.
CONCLUSION:
Patients experience three sets of inextricably linked barriers to successfully treating TB: attending the health
centre initially, attending the health centre repeatedly and experiences whilst at the health centre. These
barriers are further complicated by geography, poverty and gender. The challenge ahead lies in moving beyond
documenting barriers from patients' perspectives to addressing them in resource-poor contexts.
Goal
Improve access to comprehensive, quality health care services.
Overview
Access to comprehensive, quality health care services is important for the achievement of health equity
and for increasing the quality of a healthy life for everyone. This topic area focuses on four components of
access to care: coverage, services, timeliness, and workforce.
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Why Is Access to Health Services Important?

Access to health services means the timely use of personal health services to achieve the best health
outcomes.1 It requires 3 distinct steps:
Gaining entry into the health care system.
Accessing a health care location where needed services are provided.
Finding a health care provider with whom the patient can communicate and trust. 2
Access to health care impacts:
Overall physical, social, and mental health status
Prevention of disease and disability
Detection and treatment of health conditions
Quality of life
Preventable death
Life expectancy
Disparities in access to health services affect individuals and society. Limited access to health care impacts
people's ability to reach their full potential, negatively affecting their quality of life. Barriers to services
include:
Lack of availability
High cost
Lack of insurance coverage

These barriers to accessing health services lead to:
Unmet health needs
Delays in receiving appropriate care
Inability to get preventive services
Hospitalizations that could have been prevented 3

Back to Top
Understanding Access to Health Services

Access to health services encompasses four components: coverage, services, timeliness, and workforce.
Coverage
Health insurance coverage helps patients get into the health care system. Uninsured people are:
Less likely to receive medical care
More likely to die early
More likely to have poor health status
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4, 5, 6
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Lack of adequate coverage makes it difficult for people to get the health care they need and, when they do
get care, burdens them with large medical bills. Current policy efforts focus on the provision of insurance
coverage as the principal means of ensuring access to health care among the general population. Other
factors, described below, may be equally important to removing barriers to access and utilization of
services.
Services
Improving health care services depends in part on ensuring that people have a usual and ongoing source
of care. People with a usual source of care have better health outcomes and fewer disparities and
costs.7, 8, 9
Having a primary care provider (PCP) as the usual source of care is especially important. PCPs can
develop meaningful and sustained relationships with patients and provide integrated services while
practicing in the context of family and community.10 Having a usual PCP is associated with:
Greater patient trust in the provider
Good patient-provider communication
Increased likelihood that patients will receive appropriate care 11, 12
Related Topic Areas

Adolescent Health
Early and Middle Childhood
Lesbian, Gay, Bisexual, and Transgender Health
Maternal, Infant, and Child Health
Older Adults
Improving health care services includes increasing access to and use of evidence-based preventive
services.13, 14 Clinical preventive services are services that:
Prevent illness by detecting early warning signs or symptoms before they develop into a disease
(primary prevention).
Detect a disease at an earlier, and often more treatable, stage (secondary prevention). 15
In addition to primary care and preventive services, emergency medical services (EMS) are a crucial link in
the chain of care. EMS include basic and advanced life support. 16 Within the last several years, complex
problems facing the emergency care system have emerged. 17 Ensuring that all persons have access to
rapidly responding, prehospital EMS is an important goal in improving the health of the population.
Timeliness
Timeliness is the health care system's ability to provide health care quickly after a need is recognized.
Measures of timeliness include:
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Time spent waiting in doctors' offices and emergency departments (EDs)
Time between identifying a need for specific tests and treatments and actually receiving those
services
Actual and perceived difficulties or delays in getting care when patients are ill or injured likely reflect
significant barriers to care.18 Prolonged ED wait time:
Decreases patient satisfaction.
Increases the number of patients who leave before being seen.
Is associated with clinically significant delays in care.

Causes for increased ED wait times include an increase in the number of patients going to EDs, with much
of the increase due to visits by less acutely ill patients. At the same time, there is a decrease in the total
number of EDs in the United States.19
Learn More
Agency for Healthcare Research and Quality
AHRQ Disparity Reports
AHRQ Preventive Services
AHRQ State Snapshots
Health Resources and Services Administration
More
Workforce
PCPs play an important role in the general health of the communities they serve. However, there has been
a decrease in the number of medical students interested in working in primary care. 20 To improve the
Nation's heath, it is important to increase and track the number of practicing PCPs.
Back to Top
Emerging Issues in Access to Health Services

Access to health care services in the United States is regarded as unreliable; many people do not receive
the appropriate and timely care they need. The U.S. health care system, which is already strained, will face
an influx of patients in 2014, when 32 million Americans will have health insurance for the first time. All of
these issues, and others, make the measurement and development of new strategies and models
essential.
Specific issues that should be monitored over the next decade include:
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Increasing and measuring access to appropriate, safe, and effective care, including clinical
preventive services.
Decreasing disparities and measuring access to care for diverse populations, including racial and
ethnic minorities and older adults.
Increasing and measuring access to safe long-term and palliative care services and access to
quality emergency care.
References
1Institute
of Medicine, Committee on Monitoring Access to Personal Health Care Services. Access to health
care in America. Millman M, editor. Washington: National Academies Press; 1993.

2Bierman
A, Magari ES, Jette AM, et al. Assessing access as a first step toward improving the quality of
care for very old adults. J Ambul Care Manage. 1998 Jul;121(3):17-26.
3Agency
for Healthcare Research and Quality (AHRQ). National healthcare disparities report 2008. Chapter
3, Access to healthcare. Washington: AHRQ; 2008. Available

from: http://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/nhdr08/nhdr08.pdf
4Hadley
J. Insurance coverage, medical care use, and short-term health changes following an unintentional
injury or the onset of a chronic condition. JAMA. 2007;297(10):1073-84.

5Insuring
America's health: Principles and recommendations. Acad Emerg Med. 2004;11(4):418-22.
6Durham
J, Owen P, Bender B, et al. Self-assessed health status and selected behavioral risk factors
among persons with and without healthcare coverageUnited States, 1994-1995. MMWR. 1998
Mar;13;47(9):176-80.
7Starfield
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11Mainous
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12Starfield
B. Primary care: Balancing health needs, services and technology. New York: Oxford University
Press; 1998.
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RNTCP
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OPERATIONS RESEARCH COMMITTEE

STATE TASK FORCE, RNTCP- [Jharkhand State]

OPERATIONS RESEARCH COMMITTEE

MEDICAL COLLEGE, DHANBAD,

OPERATIONS RESEARCH COMMITTEE

2. A brief write up on usefulness of the research and its application to RNTCP

OPERATIONS RESEARCH COMMITTEE

OPERATIONS RESEARCH COMMITTEE

5. Methodology(250 words maximum):

OPERATIONS RESEARCH COMMITTEE

OPERATIONS RESEARCH COMMITTEE

OPERATIONS RESEARCH COMMITTEE

5. Contact Numbers: 9471191666,

1. Academic Councellor for PGDMCH Course,

Gandhi Open University.

OPERATIONS RESEARCH COMMITTEE

Section C: DETAILS OF THE INVESTIGATOR(S)

13. Contact Numbers: 9431184120

OPERATIONS RESEARCH COMMITTEE

OPERATIONS RESEARCH COMMITTEE

Section C: DETAILS OF THE INVESTIGATOR(S)

24. Contact Numbers:, 9955206057

Int J Tuberc Lung Dis. 2004 Dec;8(12):1479-83.

Access and adhering to tuberculosis treatment: barriers faced by

OPERATIONS RESEARCH COMMITTEE

Sanou A1, Dembele M, Theobald S, Macq J.

OPERATIONS RESEARCH COMMITTEE

Why Is Access to Health Services Important?

Gaining entry into the health care system.

Accessing a health care location where needed services are provided.

Access to health care impacts:

Overall physical, social, and mental health status

Prevention of disease and disability

Detection and treatment of health conditions

Lack of insurance coverage

Unmet health needs

Delays in receiving appropriate care

Inability to get preventive services

Hospitalizations that could have been prevented 3

Understanding Access to Health Services

Less likely to receive medical care

More likely to die early

More likely to have poor health status

OPERATIONS RESEARCH COMMITTEE

Greater patient trust in the provider

Good patient-provider communication

Increased likelihood that patients will receive appropriate care 11, 12

Related Topic Areas

OPERATIONS RESEARCH COMMITTEE

Time spent waiting in doctors' offices and emergency departments (EDs)

Decreases patient satisfaction.

Increases the number of patients who leave before being seen.

Is associated with clinically significant delays in care.

Emerging Issues in Access to Health Services

OPERATIONS RESEARCH COMMITTEE

care in America. Millman M, editor. Washington: National Academies Press; 1993.

3, Access to healthcare. Washington: AHRQ; 2008. Available

injury or the onset of a chronic condition. JAMA. 2007;297(10):1073-84.

America's health: Principles and recommendations. Acad Emerg Med. 2004;11(4):418-22.

editors. Washington: National Academies Press; 1996.

OPERATIONS RESEARCH COMMITTEE

health benefits. Washington, DC: Partnership for Prevention; Aug 2007.

General Hospital (MGH), Department of Emergency Medicine. Prehospital care:

Emergency medical service [Internet]. Boston: MGH; 2010. Available