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): ……75,000………………INR
(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

RNTCP

Page 1

Dr.Bipin kr .sinha,

[Jharkhand State] FORMAT FOR PROPOSAL SUBMISSION rd Dated (dd/mm/yyyy): ……3 Sept 2016…………… Seal of the Institution: PATLIPUTRA RNTCP MEDICAL COLLEGE. RNTCP.OPERATIONS RESEARCH COMMITTEE STATE TASK FORCE. Page 2 . DHANBAD.

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. the willingness and ability of people with HIV to access care and the quality of care they receive. workplace & health care settings and act as barriers to seeking and receiving treatment and care services. and over a million persons with both conditions are estimated to need simultaneous treatment for both diseases each year. Although TB is RNTCP Page 3 . Present knowledge/literature on the subject(200 words maximum): Tuberculosis (TB) and HIV infection are very closely linked. may help design interventions to correct this phenomena.[Jharkhand State] FORMAT FOR PROPOSAL SUBMISSION 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. PLHAs in India. RNTCP. particularly in HIV patients . There are economic . The knowledge of the health seeking behavior and reasons. 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. 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). The lifetime risk of TB in immunecompetent persons is 5-10% whereas in an HIV-infected person. TB is the most common opportunistic infection seen in HIV patients. 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 . community.the NACP and RNTCP respectively .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-. 3. Of the 34 million people living with HIV in the world . an estimated 30% have concomitant (usually latent) infection with M. Malnutrition and low body mass index (BMI < 17 ) are associated with an increased risk of mortality after antiretroviral therapy starts of 2–6 times. Little evidence is available from India regarding the incidence and mortality due to TB among ART populations . health facility barriers which may have an adverse impact on patients’ treatment access and resulting into unfavorable outcomes . social . will facilitate development of adequate strategies and messages to modify their health seeking behavior in removing stigma to increase access to TB/HIV care . face stigma and discrimination in a variety of contexts including household. Application to RNTCP Very little research from India has characterized the burden of TB in HIV‐infected persons Better understanding of the characteristics and motivations of TB/HIV patients facing problems in taking treatment . People living with HIV (PLHAs) have an increased risk of becoming infected and developing TB.27 million HIV +and in Jharkhand the prevalence has in fact increased from 0. irrespective of CD4 count. The attitude and behavior of health care providers’ influence --. 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 still an estimated 2. 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 .OPERATIONS RESEARCH COMMITTEE STATE TASK FORCE.13 in 2009 to 0.having well established cross-referral mechanisms . the annual risk of TB is 5-15% .

clinical presentation and treatment outcomes of the other (CDC 1998). A study from western India showed 57/64 HIV seropositive cases having tuberculosis (TB) . compared to 16 percent of treated patients. only 34% of TB patients (1. natural history. TB is also the leading cause of mortality in HIV infected individuals. especially in sub-Saharan Africa and increasingly in Asia and South America (WHO 2004). Data show that HIV-positive patients who take HIV prescription medicine reduce their risk of transmitting the virus to someone else by 96 percent . HIV is the most potent risk factor for reactivation of latent TB infection.3% only. Untreated patients are less knowledgeable about HIV and its potential effects than treated patients. HIV positive individuals are at increased risk of developing drug resistant TB strains. early diagnosis. and an estimated 1.000 people living with HIV and co-infected with TB. it is a leading cause of ill health and death among PLHs. 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). 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.OPERATIONS RESEARCH COMMITTEE STATE TASK FORCE. while we know that The risk of developing TB increases in patients with HIV. 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). RNTCP. but only 25 percent of untreated patients are aware being on a HIV prescription medicine reduces that risk RNTCP Page 4 . 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). 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. HIV status also influences treatment outcomes in TB patients. HIV is fuelling the TB epidemic in many countries of the world.5 million new and relapsed TB cases were reported in 2010. Similarly.7 million) were screened for HIV. the onset of TB.[Jharkhand State] FORMAT FOR PROPOSAL SUBMISSION curable. an estimated 8.4 million died. while a study from South India has found ELISA HIV seropositivity in cases of tuberculosis to the tune of 1. The TB-HIV co-epidemic is a major public health problem and is increasing cause of morbidity worldwide. and only 5% of HIV patients were screened for TB worldwide. 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. In fact. TB accelerates the course of HIV disease by increasing HIV-RNA viral loads in co-infected individuals (Garrait et al 1997). Thirty-nine percent of untreated patients believe the human body has a natural ability to fight HIV. The 2007 survey conducted by NACO has produced the prevalence of HIV among TB patients between 1% and 13. Similarly. with one in four AIDS-related deaths caused by TB. 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. These challenges may have an adverse impact on patients’ treatment access and outcomes. 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. could be the first indication of underlying HIV disease in people who are otherwise unaware of their HIV status. For this reason. Yet in 2010. Despite the fact that TB is curable and HIV is treatable. Limited treatment-specific knowledge. There exists a positive synergistic relationship between HIV and TB infections.8%. often in a site outside the lungs. compared to 63 percent of treated patients. which included 350. 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.

. 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 . Nearly one-third (30 percent) of untreated patients believe that the side effects of HIV prescription medicine are worse than HIV itself.) : Observational (Retrospective )descriptive study Sampling (simple random. attitude of health care givers will be the main outcome (dependent variable) while demographic factors (age. Dr. Methodology(250 words maximum): a. Study design (cross-sectional. Dr. 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. the we shall see to it that ethical standards of research: RNTCP Page 5 . and they can focus on the important things in their life.Avinash kumar . However. 83 percent) 4. 91 percent) and less likely to agree they will live a full life despite their HIV (72 percent vs. f. 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.S.Bipin kr . d. and 56 percent say that it has had a positive impact on their overall health and well-being.OPERATIONS RESEARCH COMMITTEE STATE TASK FORCE. Dr C. range. Variables Stigma and discrimination. Research tool : A structured questionnaire administered to ART-ATT receiving AIDS patients Plan of analysis :. 5. sex. A.S. Biswas .Suman.[Jharkhand State] FORMAT FOR PROPOSAL SUBMISSION Despite its proven efficacy.B. sinha. 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 . e. Singh . Untreated patients are less likely than treated patients to agree that their disease is well-controlled (84 percent vs. inclusion exclusion criteria if any: Descriptive statistics like mean. they’ll need to be on it for the rest of their lives Fewer positive perceptions of overall well-being. 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. one in five (20 percent) of untreated patients don’t currently take HIV prescription medicine because they believe once they start. 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. 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. cluster etc. b) To find whether HIV/AIDS related stigma effects TB control activities . frequency distributions and percentages will be used. Dr.) All patients enrolled in TB/HIV care (Census) b. Ethical aspects: In this study.Rabi Bhushan. longitudinal etc. M Dhandad will be taken for statistical analysis.K. RNTCP. education socio-economic status) will be the explanatory factors (independent variables). Inclusion criteria i) All enrolled and consenting TB/HIV patients aged > 18 years . g. Dr. Myself (Dr Matin ) along with Dr. procedures. The services of the Statistician from I .K.

000 Rs Data Entry cost Includes covering 7000 Rs 7000 Rs for the fee of statistician RNTCP Page 6 . the researcher will avoid any form of plagiarism by ensuring that all the sources of the scientific information that gets quoted in the study . PATLIPUTRA Medical College . the benefits and potential risks of the study will be obtained from each respondent. h. 6.000 Rs of all investigators and field staff Lodging & Food cost (if any) 5. Right to withdraw from the study In this study. 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.OPERATIONS RESEARCH COMMITTEE STATE TASK FORCE.[Jharkhand State] FORMAT FOR PROPOSAL SUBMISSION protection of the rights of the participants and the institution. 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. maintenance of scientific integrity of the research and dissemination of the research findings are ensured . Respect for human dignity To ensure respect and dignity for the respondents. the respondents will be informed of their right to withdraw from the study at any time they wish so if they feel uncomfortable. their rights.000 Rs 5. all respondents before signing the consent will be briefed about the study objectives. respondents will be assured that all their responses and information obtained from them during the study will not be disclosed to anyone. The respondents will be made to sign to the consent only after voluntarily accepting to participate in the study. For the purpose of confidentiality. 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 .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 . However all heads relevant for your study should be included as new rows. 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.000 Rs 25.000 Rs investigator(s) Travel Cost (if any) To cover travel cost 25.They will work for free Honorarium for field 300 Rs 2 25 15. the benefits and potential risks. will be acknowledged and correctly referenced. RNTCP.DHANBAD. Data collection will be done in a socially conducive environment and secluded venue. Scientific Integrity of the research When carrying out the study. Confidentiality and anonymity To ensure confidentiality and anonymity. even if it is not mentioned in the template below) No. They will also be assured that their withdrawal will not affect their studies at A Grade Nursing School. data will be coded with numbers instead of names. Budget: Submit the budget following a pattern as given below (PS: It is not mandatory to follow the same heads while preparing the budget. No.

..................000 Rs sub-Total GRAND-TOTAL 75............Seventyfive Thousand only ................... RNTCP.. RNTCP Page 7 ....000 Rs In Words: ......000 Rs Over-Head Costs (Max 4% of 3..... journal submission charges 15........000 Rs 15..OPERATIONS RESEARCH COMMITTEE STATE TASK FORCE.........................000 Rs etc if any) SUB-TOTAL: 72..................[Jharkhand State] FORMAT FOR PROPOSAL SUBMISSION Stationery 5000 Rs 5000 Rs Miscellaneous (IEC Charges...........................

if any) Srl. Educational qualification (Not to mention those below MBBS) Degree Institution Year MBBS DMCH.S.Patna 1985 Specify Subjects Medical Subjects P. Academic Councellor for PGDMCH Course. 1. Research or Training Experience (Do not include your Thesis. Contact Numbers: 9471191666.OPERATIONS RESEARCH COMMITTEE STATE TASK FORCE. 6. 8. Complete Postal Address with pincode: Patliputra Medical College . 7. RNTCP.Public Health.Dhanbad . Master trainer in Disability prevention and rehabilitation. Medical Education. Training on Acconutancy from State Institute of Rural Development.Darbhanga 1978 M. Indira Gandhi Open University.D PMCH.826005 4.PMC Dhanbad 3. R. RNTCP trainer from june 2004.C. RNTCP Page 8 .com 5. Ranchi (SIRD) 7. Trained for Management Development Programme on Behavioural Skills for Senior Health Administrators. 5. Major areas of research interest/ area of specialisation:TB/HIV Care. 4. Trainer from January 2000 3. 6. Duration Institution Particulars No.Training in Educational Science and Technology in 1.PSM Principal . 8. Email :principalpmc@gmail.H. Training of Childhood Psychiatric disorder. . First Name: …DR Arun…… Surname: Kumar……………………………………… 2.[Jharkhand State] FORMAT FOR PROPOSAL SUBMISSION 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.M . 2. Designation with Department: Prof .

1. RNTCP. Title of article/ chapter/ Peer Reviewed Journal Name No publication Journal? (Yes/No) . you may also mention papers currently in-press Srl .[Jharkhand State] FORMAT FOR PROPOSAL SUBMISSION Section – C: DETAILS OF THE INVESTIGATOR(S) (Information submitted must be relevant to research and teaching experience only. First Name: …DR MATIN AHMAD…… Surname: KHAN……………………………………… 10.submit Section C separately for each investigator in case of more than oneinvestigator) 9.com 13. Duration Institution No. March Yes Public Health Vol 3 No 2 2011 (ISSN 2011 I986-5872) International Journal of Collaborative Blips and its clinical Research on Internal Medicine & 2 relevance in HIV Patients Yes Public Health Vol 4 No 6 2012 (ISSN on Treatment. TB/HIV Care 17.Dhanbad 826005 12. June 2012 I986-5872 3 A Pharmacogenomical International Journal of Collaborative Yes perspective in HIV/AIDS Research on Internal Medicine & RNTCP Page 9 . Contact Numbers: 9431184120 14. Research or Training Experience (Do not include your Thesis. Recent publications (last 5 publications only if any). DMRD 1993 Ranchi School of Tropical Fellowship in HIV Medicine (STM) and 2007 Medicine Medical College . 16. Major areas of research interest/ area of specialisation: HIV Medicine .OPERATIONS RESEARCH COMMITTEE STATE TASK FORCE. 5 daysx2 =10 days RNCTP Specify Subjects Medical Subjects Radio-diagnosis HIV Medicine Particulars RNTCP . Email :mak5962@hotmail. Complete Postal Address with Pin code: Patliputra Medical College . 15. Designation with Department: Associate Prof Deptt of Biochemistry 11. if any) Srl. Dhanbad 1987 RMCH(RIMS) . Kolkata . International Journal of Collaborative Treatment of AIDS : A Research on Internal Medicine & 1 Prevention Pill’. Educational qualification (Not to mention those below MBBS) Degree Institution Year MBBS PMCH .

presentations conference A case scenario involving different AIDS Society of India 12-14th 1 Kolkata modalities (ASICON) 2014 Dec. Title of paper/ poster Name of the Venue Dated No. 18.[Jharkhand State] FORMAT FOR PROPOSAL SUBMISSION Public Health Vol 4 No 6 2012 (ISSN Therapies June 2012 I986-5872) International Journal of Collaborative : Has a time to talk about Research on Internal Medicine & cure of AIDS arrived? Public Health Vol 4 No 6 2012 (ISSN June 2012 I986-5872 Cure : Its meaning in the JIMA Journal of Indian Medical context of HIV/AIDS Association Yes Yes .2014 of HIV /AIDS and Treatment of IMA Annual 2 Jamshedpur March 2013 AIDS : A Prevention Pill Conference 3 4 5 19. Recent conference paper/poster presentations (last 5 paper/poster presentations only if any) Srl. Give details of financial support received from other sources if any N/. RNTCP.A RNTCP Page 10 .4 5 OPERATIONS RESEARCH COMMITTEE STATE TASK FORCE.

OPERATIONS RESEARCH COMMITTEE STATE TASK FORCE. 27. Recent publications (last 5 publications only if any).dhanbad .IDSP . Designation with Department: Tutor. Duration Institution Particulars No. Research or Training Experience (Do not include your Thesis. First Name: Dr. if any) Srl. 28. 1 Week Chandigarh MASTER TRAINER:.U. 1 2 3 4 5 .[Jharkhand State] FORMAT FOR PROPOSAL SUBMISSION Section – C: DETAILS OF THE INVESTIGATOR(S) (Information submitted must be relevant to research and teaching experience only. Email : rbhushan07@gmail. Major areas of research interest/ area of specialisation :-Epidemiology. 26. RNTCP Page 11 . Contact Numbers:. 9955206057 25. Title of article/ chapter/ Peer Reviewed Journal Name No publication Journal? (Yes/No) . RNTCP. Int J Tuberc Lung Dis. PSM 22. Educational qualification (Not to mention those below MBBS) Degree Institution Year Specify Subjects MBBS DMC. 2004 Dec. Public Health. Rabi … …… Surname: Bhushan……………………………………… 21.RRT 1 Week Bhuvaneshwar TRAINING OF TRAINERS:. Complete Postal Address with PINCODE:Patliputra Medical College .O. Access and adhering to tuberculosis treatment: barriers faced by patients and communities in Burkina Faso.DELHI 2013 Epidemiology MPH G.Darbhanga 2003 Medical Subjects Dip-EPIDEMIOLOGY IIPH.submit Section C separately for each investigator in case of more than oneinvestigator) 20. 1.com 24.ICD-X & ICF 1 Week Lucknow MASTER TRAINER:.8(12):1479-83. 2016 Public Health . you may also mention papers currently in-press Srl .826005 23.

Theobald S. patients faced a number of barriers in adhering to care. Author information Abstract SETTING: Three selected districts in Burkina Faso. community representatives. and workforce. This topic area focuses on four components of access to care: coverage. RESULTS: Attending the health centre was the last resort for patients with symptoms indicative of TB. Overview Access to comprehensive. members of the health centre management committee. CONCLUSION: Patients experience three sets of inextricably linked barriers to successfully treating TB: attending the health centre initially.[Jharkhand State] FORMAT FOR PROPOSAL SUBMISSION Sanou A1. and 2) to identify patients' and community members' perceptions and problems associated with adhering to formal TB treatment.OPERATIONS RESEARCH COMMITTEE STATE TASK FORCE. traditional healers and health professionals. poverty and gender. Dembele M. These barriers are further complicated by geography. When on treatment. RNTCP. attending the health centre repeatedly and experiences whilst at the health centre. quality health care services is important for the achievement of health equity and for increasing the quality of a healthy life for everyone. timeliness. services. Goal Improve access to comprehensive. RNTCP Page 12 . The challenge ahead lies in moving beyond documenting barriers from patients' perspectives to addressing them in resource-poor contexts. These related to the centralised nature of direct observation and the problems faced whilst at the treatment unit. quality health care services. OBJECTIVES: 1) To explore patients' and community members' perceptions and problems associated with accessing formal tuberculosis (TB) treatment. METHODS: Twenty-eight focus group discussions and 68 in-depth interviews with TB patients. Macq J.

1 It requires 3 distinct steps:  Gaining entry into the health care system.OPERATIONS RESEARCH COMMITTEE STATE TASK FORCE.  Accessing a health care location where needed services are provided.[Jharkhand State] FORMAT FOR PROPOSAL SUBMISSION 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. Limited access to health care impacts people's ability to reach their full potential. 5. services. negatively affecting their quality of life. Uninsured people are:  Less likely to receive medical care  More likely to die early  More likely to have poor health status RNTCP 4. 6 Page 13 . timeliness. social. RNTCP.  Finding a health care provider with whom the patient can communicate and trust. 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. and workforce. 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. 2  Access to health care impacts:  Overall physical. Coverage Health insurance coverage helps patients get into the health care system.

Other factors. EMS include basic and advanced life support. described below. Bisexual. complex problems facing the emergency care system have emerged. 17 Ensuring that all persons have access to rapidly responding. may be equally important to removing barriers to access and utilization of services.7. Gay.13. PCPs can develop meaningful and sustained relationships with patients and provide integrated services while practicing in the context of family and community. burdens them with large medical bills. 9 Having a primary care provider (PCP) as the usual source of care is especially important.[Jharkhand State] FORMAT FOR PROPOSAL SUBMISSION Lack of adequate coverage makes it difficult for people to get the health care they need and. and Transgender Health Maternal. 14 Clinical preventive services are services that:  Prevent illness by detecting early warning signs or symptoms before they develop into a disease (primary prevention).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. 8. Current policy efforts focus on the provision of insurance coverage as the principal means of ensuring access to health care among the general population. 12 Related Topic Areas Adolescent Health Early and Middle Childhood Lesbian. emergency medical services (EMS) are a crucial link in the chain of care. prehospital EMS is an important goal in improving the health of the population.OPERATIONS RESEARCH COMMITTEE STATE TASK FORCE. Services Improving health care services depends in part on ensuring that people have a usual and ongoing source of care. and often more treatable. Timeliness Timeliness is the health care system's ability to provide health care quickly after a need is recognized. when they do get care. People with a usual source of care have better health outcomes and fewer disparities and costs. and Child Health Older Adults Improving health care services includes increasing access to and use of evidence-based preventive services. Measures of timeliness include: RNTCP Page 14 . 16 Within the last several years. 15 In addition to primary care and preventive services. RNTCP. Infant.  Detect a disease at an earlier. stage (secondary prevention).

All of these issues.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. At the same time. and others. it is important to increase and track the number of practicing PCPs.  Increases the number of patients who leave before being seen. The U. when 32 million Americans will have health insurance for the first time. will face an influx of patients in 2014. make the measurement and development of new strategies and models essential. there is a decrease in the total number of EDs in the United States. Specific issues that should be monitored over the next decade include: RNTCP Page 15 . RNTCP.  Is associated with clinically significant delays in care.S. many people do not receive the appropriate and timely care they need.OPERATIONS RESEARCH COMMITTEE STATE TASK FORCE. health care system. with much of the increase due to visits by less acutely ill patients. Back to Top Emerging Issues in Access to Health Services Access to health care services in the United States is regarded as unreliable.18 Prolonged ED wait time:  Decreases patient satisfaction. there has been a decrease in the number of medical students interested in working in primary care. which is already strained. However. 20 To improve the Nation's heath. Causes for increased ED wait times include an increase in the number of patients going to EDs.[Jharkhand State] FORMAT FOR PROPOSAL SUBMISSION  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.

Washington: National Academies Press.47(9):176-80. Shi L. 1994-1995.1:144-8. Available from: http://www.ahrq. Magari ES. 7Starfield B.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/nhdr08/nhdr08.11(4):418-22. and effective care. et al. Millman M. Access to healthcare. services and technology. and short-term health changes following an unintentional injury or the onset of a chronic condition. Lohr KN. 2nd ed. 1998 Mar. References 1Institute of Medicine. JAMA.13. 5Insuring America's health: Principles and recommendations. including clinical preventive services. et al.33(1):22-7. Office of Disease Prevention and Health Promotion. Available from: http://www. Primary care: Balancing health needs. Healthy People 2010. Primary care: America's health in a new era. With understanding and improving health and objectives for improving health. including racial and ethnic minorities and older adults. De Prins L. et al. 2003. safe. Jette AM. The medical home.113(5 suppl):1493- 8. RNTCP Page 16 . access to care. 11Mainous AG 3rd. New York: Oxford University Press. 1998 Jul. Access to health care in America. Acad Emerg Med.121(3):17-26.[Jharkhand State] FORMAT FOR PROPOSAL SUBMISSION  Increasing and measuring access to appropriate. Pediatrics. 9US Department of Health and Human Services. Self-assessed health status and selected behavioral risk factors among persons with and without healthcare coverage—United States. Love MM. Nov 2000.297(10):1073-84. 3Agency for Healthcare Research and Quality (AHRQ).healthypeople.45. Provider continuity in family medicine: Does it make a difference for total health care costs? Ann Fam Med. Washington: Government Printing Office. MMWR. Donaldson MS. Chapter 3. National healthcare disparities report 2008. editor. 1998. Assessing access as a first step toward improving the quality of care for very old adults. Washington: AHRQ. 1993. RNTCP.gov 10 Institute of Medicine. J Ambul Care Manage. Continuity of care and trust in one's physician: Evidence from primary care in the United States and the United Kingdom. Yordy KD. Owen P. Washington: National Academies Press. Baker R.  Decreasing disparities and measuring access to care for diverse populations. p. 2 vols. 1996.OPERATIONS RESEARCH COMMITTEE STATE TASK FORCE. 2004. 2008. medical care use. editors. Fam Med. Insurance coverage. Gosset C. Committee on Monitoring Access to Personal Health Care Services. et al. 6Durham J. 2001 Jan. 12Starfield B. 2004. Bender B. 2Bierman A. 2007.  Increasing and measuring access to safe long-term and palliative care services and access to quality emergency care. 8De Maeseneer JM. and insurance.pdf 4Hadley J.

pdf 19Hsai RY. Preventive care: A national profile on use.org/uspstf08/methods/procmanual. Data needed to assess use of high-value preventive care: A brief report from the National Commission on Prevention Priorities. House JS. US graduate medical education.294(9):1075-82. Paper presented at: Annual Meeting of the American Sociological Association. et al. DC: Partnership for Prevention.169(20):1826-1932. Aug 2007. Washington.harvard. Available from: http://www. Access to healthcare. Department of Emergency Medicine. Etzel SI.mgh. Lantz PM. Rockey PH. 20Brotherton SE. 09-0002). Washington: IOM. Washington: Agency for Healthcare Research and Quality. Arch Intern Med. Montreal.edu/emergencymedicine/services/treatmentprograms.ahrq. Aug 2007. RNTCP Page 17 . The increasing weight of increasing waits.uspreventiveservicestaskforce.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/nhdr08/nhdr08. Available from: http://www. 15Rose DJ.htm 16Massachusetts General Hospital (MGH). 2009 Nov 9.OPERATIONS RESEARCH COMMITTEE STATE TASK FORCE.[Jharkhand State] FORMAT FOR PROPOSAL SUBMISSION 13National Commission on Prevention Priorities.aspx?id=1433 17Institute of Medicine (IOM). 2006 Aug 10. Washington: Partnership for Prevention. Chapter 3. Quebec. 14National Commission on Prevention Priorities. Health care access and the use of clinical preventive services. Future of emergency care series: Emergency medical services: At the crossroads. 2010. 18Agency for Healthcare Research and Quality. National healthcare disparities report 2008 [Internet]. Prehospital care: Emergency medical service [Internet]. JAMA. disparities. Tabas JA. Available from: http://www. 2004-2005: Trends in primary care specialties. 2008. 2006. (AHRQ publication. no. RNTCP. Boston: MGH. and health benefits. 2005 Sep 7.