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

Tucker, A., Mithoo, J., Cleary, P., Woodhead, M., MacPherson, P. , Wingfield, T., Davies, S., Wake, C., McMaster, P. and Bertel Squire, S. (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, 17, 881. (doi: 10.1186/s12889-017-4892-5) (PMID:29141600) (PMCID:PMC5688729)

Abstract

Background: 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. Methods: 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. Results: 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). Conclusions: 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: Articles
• Additional Information: Jeniffer Mithoo is a PhD student funded by The National Institute of Health Research CLAHRC NWC (NIHR CLAHRC NWC).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: MacPherson, Professor Peter
• Authors: Tucker, A., Mithoo, J., Cleary, P., Woodhead, M., MacPherson, P., Wingfield, T., Davies, S., Wake, C., McMaster, P., and Bertel Squire, S.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: BMC Public Health
• Publisher: BioMed Central
• ISSN: 1471-2458
• ISSN (Online): 1471-2458
• Copyright Holders: Copyright © The Author(s) 2017
• First Published: First published in BMC Public Health 17:881
• Publisher Policy: Reproduced under a Creative Commons licence