Details of the correct management of SPs are given in Table 1 . Required drugs and lab tests come from the Tanzanian Standard Treatment Guidelines [32 ]. Details of the classification of drugs and tests as palliative, appropriate and unnecessary have been published elsewhere [7 (link)]. Quality of care is measured with two binary outcomes: correct management (SP was prescribed or ordered the required drugs and tests) and unnecessary care (SP was prescribed or ordered any test not categorised as appropriate or any drug not categorised as required or palliative). Correct management and unnecessary care are not mutually exclusive, and can occur within the same SP visit. The unnecessary care outcome is equivalent to overprovision.
Total fees for all services received were converted from Tanzanian shilling to US dollars using the World Bank official exchange rate average for 2018 (2,263.78 TZS = 1.00 USD). Where available, a breakdown of separate fees paid for consultation with the clinician, lab tests and drugs is reported.
Total fees for all services received were converted from Tanzanian shilling to US dollars using the World Bank official exchange rate average for 2018 (2,263.78 TZS = 1.00 USD). Where available, a breakdown of separate fees paid for consultation with the clinician, lab tests and drugs is reported.
Standardised patient (SP) case presentation and correct management
| Case | Initial presentation | Further details given if probed | Required drugs and tests | Palliative drugs¹ | Appropriate tests² |
|---|---|---|---|---|---|
| Asthma | “I have had a problem with breathing, and last night it became terrible” | Shortness of breath when moving furniture/cleaning. Wheezing and non-productive cough throughout attack. Attacks at night for a year with increasing frequency and severity. Attacks brought on by cleaning or physical activity. Had coughing fits as a child, and a sibling with a similar problem. | Prescription of salbutamol or other beta-2 antagonist or steroid inhaler. | Other \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${ \beta }_{2}$$\end{document} | Allergy tests, ECG, HIV, X-ray. |
| TB | “I have had a cough that is not getting better” | Productive cough for three weeks, one week course of amoxicillin without improvement. Low grade fevers, chest pain, loss of appetite, weight loss, night sweats. | Order or refer for sputum TB testing (including referral to a higher-level public health facility which could test for TB, even if testing was not mentioned). | Cold and flu combinations, cough syrups, NSAIDs and paracetamol. | Complete blood count, HIV, malaria, X-ray, Widal. |
¹Drugs which are suitable for managing symptoms associated with the condition, and therefore not classified as unnecessary
²Tests which may give the provider useful information in planning management of the patient
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