Poster sessions A88Thorax 2012;67(Suppl 2):A1-A204-Whitechapel, for culture and sensitivity testing with first line anti-tuberculous drugs. Sex, Age (Decade), HIV status, disease site (pulmonary or extra pulmonary) and resistance to any first line drug were evaluated to see whether they were associated with "ost to follow up", as opposed to all other outcomes, using chi-square test for proportions. Objectives To assess the safety and effectiveness of a pharmacistled LTBI clinic. Methods Patients identified by screening as having LTBI were seen by TB pharmacist at the weekly TB clinic. Initial interview included history of symptoms to exclude active TB. Baseline bloods were taken as well as a screen for blood borne viruses. Follow up appointments were scheduled at 2 weeks, one month and at the end of treatment. The TB pharmacist obtains written consent for therapy, dispenses medication and information leaflets regarding potential drug adverse effects. At follow-up appointments the pharmacist evaluates treatment adherence and potential adverse effects. TREATMENT AND DRUG SURVEILLANCE OF LATENT TUBERCULOSIS INFECTIONS (LTBI) BYResults 62 latent TB patients were seen from 01/05/11 to 01/05/12. All patients were discussed at the TB-MDT. 51 (82%) patients were allocated to the pharmacist led clinic. The 11 (18%) patients seen by the Consultant Respiratory Physician had significant co-morbidities at initial interview, but subsequently were followed up by the pharmacist. Of the 51 patients, 50 started therapy and 1 patient did not attend the appointment. 9 (18%) patients reported adverse drug reaction. 46 (92%) patients successfully completed treatment, 3 (6%) patients did not complete therapy due to side effects and 1 (2%) patient was lost to follow up. The patient who did not attend subsequently developed active TB during the study period. Of the 9 adverse drug reactions reported, only 3 required treatment to be discontinued. No adverse drug reaction occurred due to drug interaction. Conclusion A pharmacy-led clinic for LTBI is feasible and safe.Patients were happy to be seen by the pharmacist. Patients with poly-pharmacy benefited as they had a medication review to maximise therapy and reduce adverse drug reactions. HOW OFTEN DO PATIENTS WITH TUBERCULOSIS REQUIRE ENHANCED CASE MANAGEMENT?doi: 10.1136/thoraxjnl-2012-202678.201 A Gebril, C Bell, M Woodhead.
IntroductionIn 2014, over 500 workers in a local factory were screened for TB. 3 cases of active pulmonary TB were identified and seen in the next weekly TB Clinic. 128 workers were identified for further assessment by the local TB Service, of whom 100 were found to be IGRA-reactive. This was declared a major incident and a TB Action Group was set up to facilitate additional out-of-hours TB clinics.MethodsThe local CCG commissioned the additional TB clinics at standard respiratory out-patient tariff: approximately 35 workers were to be assessed by 5 TB clinicians in 2 weekly sessions (18:00–21:00 – 20 min slots) for the first 2 weeks, so that by week 3, all workers would be assessed. As in the weekly TB Clinic, the TB Pharmacy Team would be present to dispense TB medication with drug information leaflets and contact details. Chemoprophylaxis for LTBI was offered to all workers with reactive IGRA and no evidence of active TB independent of their age despite NICE guidance.ResultsOf the 100 workers with reactive IGRA: 18 did not attend; 82 were offered chemoprophylaxis of whom 15 declined treatment; 67 started chemoprophylaxis of whom only 33 completed 3 months treatment with rifampicin and isoniazid. The rate of completion of chemoprophylaxis in the eligible group was 9/35 (25.7%) compared to 24/47 (51.1%) in the over 35 year olds. There was a transient rise in liver enzymes in 1 worker aged over 35 but otherwise there were no other significant side-effects.DiscussionIt is difficult to deny chemoprophylaxis for LTBI infection on the basis of age in a large screening event such as this when the average age is 40 (range 17–63) and the oldest member of the cohort tolerated chemoprophylaxis without significant side-effects. The reasons for reluctance to continue chemoprophylaxis in this cohort are poorly understood although lifestyle issues such as reducing alcohol consumption were perceived to be barriers to successful completion of treatment.ConclusionChemoprophylaxis for LTBI in this cohort was not tolerated in the eligible population. When undertaking mass screening, it is important to ensure that non-standard treatment is funded, if this is to be offered. Treatment of the over 35s significantly increased the workload and cost of this cohort, although uptake of chemoprophylaxis and successful completion was twice that of the workers aged 35 or less.
BackgroundEarly identification of non-compliance in patients taking anti-tuberculous therapy (ATT) may improve treatment outcomes and prevent the emergence of drug therapy resistance. Since 2012, the TB Pharmacy Team has been tablet counting to identify missed doses. Strategies to improve ATT compliance such as provision of dosette boxes, more frequent appointments and directly observed therapy (DOT) can then be initiated.AimTo evaluate the usefulness of tablet counting as an effective strategy to help identify and reduce non-compliance with ATT.MethodsA retrospective review of active TB cases diagnosed between January 2012 to December 2016 was undertaken. Objective compliance was graded according to accuracy of tablet counting. Treatment outcomes were assessed clinically and subsequent change from normal practice identified.Results248 persons received at least 2 months ATT from the TB Clinic and were further evaluated. The majority of persons (87.5%) were graded as fully (61.3%) compliant (accurate tablet counting) or mostly (26.2%) compliant (few missed doses) both with good clinical response. The commonest strategy to improve treatment outcome in 25 (10.1%) with partial compliance (missed doses with adequate clinical response) was to increase duration of therapy. Poor compliance (missed doses, poor clinical response, more than 1 non-attendance) in 4 patients resulted in admission and completion of DOT as an in-patient. NICE guidance would have identified 22 persons for DOT. 19/22 received DOT (2 MDR-TB; 12 prisoners; 3 homelessness, 2 intravenous iv drug users). 3 (2 with mental health disorders; 1 alcohol dependence) successfully completed therapy with increased frequency of appointments and family involvement. Tablet counting identified 25 partially compliant persons (12 had no obvious risk factor; 5 prisoners on DOT; 2 persons with mental health disorders and 1 with alcohol dependence as above; 3 HIV; 2 pregnant). Treatment outcomes were adequate although 11/25 were lost to follow-up (did not attend their end of treatment consultation) including 5 prisoners (released or transferred).ConclusionsTreating TB in prisoners and homeless persons continues to be a challenge, even when DOT is undertaken. Tablet counting can help identify potential non-compliance in persons without obvious risk factors. In our experience, tablet counting is an effective and relatively cheap objective adjunct in the assessment of ATT compliance.
IntroductionPreviously we have reported good outcomes following a pilot study of latent TB infection (LTBI) assessment and treatment by a dedicated TB Pharmacist.1 Since that time, the service has been imbedded within our local practice to reduce waiting times, improve chemoprophylaxis adherence, enhance treatment outcomes, and minimise adverse drug reactions whilst maintaining a high standard of care. In addition, patients with more complex medical needs requiring biological therapy are now not excluded from this service.Aimto review the safety and effectiveness of the Pharmacy-led ClinicMethodsMedical records of all cases of LTBI seen by the TB Pharmacist were reviewed retrospectively. Data obtained included patient demographics, treatment ± side-effects and clinical outcomes.Results206 patients with LTBI seen between Jan 2012 and December 2015 were identified (see Table 1). Contact tracing and the requirement for biological therapy were the commonest reasons for referral. 185 (89.8%) successfully completed treatment: 3 declined; 8 lost to follow up; 10 stopped due to side-effects. Significant drug side-effects included hepatitis, peripheral neuropathy, nausea and vomiting and only resulted in 2 non-completion, the rest were due to fatigue and headache. Of the 8 who stopped 1 developed active TB whilst on biological therapy. Patient satisfaction was good and patients would recommend this service to a friend or family member.ConclusionThe LTBI Pharmacy-led clinic has been successfully implemented and incorporated into our local TB practice with good outcomes. Keeping with the Carter Review,2 it is important to utilise the skills and knowledge of previously unrecognised clinical partners to deliver high quality care. Patients were happy to be seen by the pharmacists. Poly pharmacy patients appreciated time spent to simplify regime and manage potential interaction.ReferencesAbunga YO, Luwemba G, Brij SO. Diagnosis and management of TB: P59 Treatment and Drug Surveillance of Latent Tuberculosis Infections (LTBI) by a TB Pharmacist: A pilot study. Thorax 2012;67(Suppl 2):A88.Department of Health. Independent report – Productivity in NHS hospitals [ONLINE]. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/499229/Operational_productivity_A.pdf (Accessed 6 July 2016).Abstract P117 Table 1Number(%) Declined treatmentLost to follow-upStopped due to side-effectsContact screening105(50.9)188Biological therapy71(34.4)102New entrant screening 18(8.7)100Occupational health12(5.8)000 Total number of patients seen 2063810
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