Delay and completion of tuberculosis treatment: a cross-sectional study in the West Midlands, UK.

BACKGROUND: TB remains a significant problem in the UK with the West Midlands having the highest incidence after London. Treatment is usually for a minimum of 6 months and requires a high level of compliance. We investigated potential determinants of delays and completion of treatment for tuberculosis (TB) in the West Midlands, UK. METHODS: We used data on 4840 patients with TB in the West Midlands from the Enhanced Tuberculosis Surveillance database from 1 January 2005 to 1 October 2010. We used regression models to investigate the cross-sectional association between sociodemographic and clinical risk factors and the timeliness and completion of TB treatment. RESULTS: Patients with TB waited 82 days on average from symptom onset to treatment initiation. Female patients spent 6% longer time than males before receiving treatment [95% confidence interval (CI): 1.2-11.6%, P = 0.015]. Asian/Asian British patients were 11 times more likely to complete treatment than White patients (adjusted odds ratio: 11.4, 95% CI: 1.31-100.3, P = 0.028). CONCLUSIONS: Females in the West Midlands took longer time to receive TB treatment than males, representing a health inequality that could be addressed through gender-sensitive awareness raising programmes. White patients were less likely to complete treatment than Asian/Asian British patients; additional support is needed in this group.

Valuing telecare using willingness to pay from the perspective of carers for people with dementia: a pilot study from the West Midlands.

We carried out a cost-benefit analysis of the STAY telecare service (Sandwell Telecare Assisting You) for unpaid carers of people with dementia in the West Midlands. This was done from the perspective of the carers. We employed the willingness to pay (WTP) approach, an established economic method to quantify the benefits of healthcare. A questionnaire was given to 87 unpaid carers of people with dementia, and 34 completed questionnaires were returned (39%). Two WTP question designs were used (open-ended and bounded style). The annual mean WTP for telecare was £242-310 per person. Carers offered higher values if the cared-for person was suffering from moderate dementia. Carers offered WTP values that were similar to the resource costs of providing telecare services. The pilot study suggests that the provision of telecare for unpaid carers of people with dementia is beneficial to society.

Telehealth as 'peace of mind': embodiment, emotions and the home as the primary health space for people with chronic obstructive pulmonary disorder.

A theoretical understanding of why some people with chronic obstructive pulmonary disorder (COPD) experienced 'peace of mind' when a new telehealth service was introduced into a community respiratory service (CRS) is presented in this article. This is based on analysis of in-depth, qualitative, situated interviews with COPD patients who were receiving the service. Telehealth brought peace of mind through two mechanisms: legitimising contact with health professionals and increased patient confidence in the management of their condition. When the home is the primary health space, the introduction of telehealth can modify emotional and bodily experiences to an extent that is significant for people with COPD. The process by which technology can provide 'peace of mind' to people with long term conditions should be taken into account when designing or commissioning a service.