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Quantifying the need for enhanced case management for TB patients as part of TB cohort audit in the North West of England: a descriptive study.

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Tucker, Angela, Mithoo, Jeniffer, Cleary, Paul, Woodhead, Mark, MacPherson, Peter ORCID: https://orcid.org/0000-0002-0329-9613, Wingfield, Tom, Davies, Stefanie, Wake, Carolyn, McMaster, Paddy and Squire, Bertie ORCID: https://orcid.org/0000-0001-7173-9038 (2017) 'Quantifying the need for enhanced case management for TB patients as part of TB cohort audit in the North West of England: a descriptive study.'. BMC Public Health, Vol 17, Issue 1, p. 881.

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Abstract

Patients with TB have diverse and often challenging clinical and social needs that may hamper successful treatment outcomes. Understanding the need for additional support during treatment (enhanced case management, or ECM) is important for workforce capacity planning. North West England TB Cohort Audit (TBCA) has introduced a 4-level ECM classification system (ECM 0-3) to quantify the need for ECM in the region. This study describes the data from the first 2 years of ECM classification. Data collected between April 2013 and July 2015 were used to analyse the proportions of patients allocated to each ECM level and the prevalence of social and clinical factors indicating need for ECM. Single variable and multivariable logistic regression models were constructed to examine the association between ECM level and treatment outcome. Of 1714 notified cases 99.8% were assigned an ECM level: 31% ECM1, 19% ECM2 and 14% ECM3. The most common factors indicating need for ECM were language barriers (20.3%) and clinical complexity (16.9%). 1342/1493 (89.9%) of drug-sensitive, non-CNS cases completed treatment within 12 months. Patients in ECM2 and 3 were less likely to complete treatment at 12 months than patients in ECM0 (adjusted OR 0.47 [95% CI 0.27-0.84] and 0.23 [0.13-0.41] respectively). Use of TBCA to quantify different levels of need for ECM is feasible and has demonstrated that social and clinical complexity is common in the region. Results will inform regional workforce planning and assist development of innovative methods to improve treatment outcomes in these vulnerable groups.

Item Type: Article
Subjects: WA Public Health > WA 4 Works on general hygiene
WA Public Health > Statistics. Surveys > WA 900 Public health statistics
WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General)
WF Respiratory System > Tuberculosis > WF 205.1 General coverage
WF Respiratory System > Tuberculosis > WF 310 Therapy
WF Respiratory System > Tuberculosis > WF 315 Diet. Rest. Exercise. Home care
WY Nursing > WY 106 Community health nursing
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.1186/s12889-017-4892-5
SWORD Depositor: JISC Pubrouter
Depositing User: Stacy Murtagh
Date Deposited: 27 Nov 2017 12:41
Last Modified: 27 Nov 2017 12:41
URI: http://archive.lstmed.ac.uk/id/eprint/7870

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