Educational outreach to promote screening for tuberculosis in primary care: a cluster randomised controlled trial

Griffiths, Chris; Sturdy, Pat; Brewin, P.; Bothamley, Graham; Eldridge, Sandra; Martineau, Adrian R.; MacDonald, Meg; Ramsay, Jean; Tibrewal, Suresh; Levi, Sue; Zumla, Alimuddin; Feder, Gene

doi:10.1016/s0140-6736(07)60707-7

Cited by 60 publications

(51 citation statements)

References 20 publications

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“…It is possible that the intervention has raised the awareness of clinicians about TB, also during consultations at the health services, and better targeted screening was applied. Similar observations were done in cluster randomised controlled trials in the UK and South Africa where educational outreach to promote screening for tuberculosis in primary health care improved case-finding (Fairall et al 2005;Griffiths et al 2007). Overall, the PTB case detection rate in the population increased fourfold.…”

Section: Discussionsupporting

confidence: 71%

Pulmonary tuberculosis case detection through fortuitous cough screening during home visits

Brooks

Matthys

et al. 2009

Tropical Med Int Health

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Summary Objective To compare the yield of active tuberculosis (TB) case detection among risk groups during home visits with passive detection among patients at health services. Methods In April 2004, in a first phase, we introduced, active screening for coughing among all family members of patients that were visited at home by their family doctor or nurse for other reasons. Subsequently, from October 2004 onwards, active screening was restricted to family members belonging to groups at risk of TB. Results The overall detection rate of TB increased from 6.7/100 000 during passive detection at health services before the intervention to 26.2/100 000 inhabitants when passive detection was complemented by active case finding. Active screening among risk groups yielded 35 TB cases per 1000 persons screened compared to 20 TB cases per 1000 persons passively screened at health services. Active case finding was particularly efficient in those coughing for 3 weeks or more (107/1000 screened). Conclusion This study demonstrates that active case finding in groups at risk during home visits increases the case detection rate in the population and permits the identification of cases that may not be detected through passive case finding at health facility level.

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Section: Discussionsupporting

confidence: 71%

Pulmonary tuberculosis case detection through fortuitous cough screening during home visits

Brooks

Matthys

et al. 2009

Tropical Med Int Health

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“…121,[134][135][136] Provider barriers to offering screening to migrants are related to inadequate knowledge of which migrants should be screened or how they should be followed up. [137][138][139] Low adherence to treatment for latent tuberculosis infection is associated with barriers similar to those with screening latent tuberculosis. They include linguistic barriers, cultural taboos and stigmatization, low education level, perceived low risk of progressing from latent tuberculosis infection to active disease, belief that positive results from tuberculin skin tests are due to BCG, not wanting to have venipunctures, and economic factors (costs of travel, lack of insurance, delays in obtaining insurance, missed days at work).…”

mentioning

confidence: 99%

“…134,136,[140][141][142] Increased adherence to tuberculin skin test screening has been seen with patient reminders (e.g., letters, phone calls), education of patients and physicians, and novel strategies, such as drive-by tuberculin skin test readings for taxi drivers. 137,139,143 One study educating primary care providers on how and whom to screen for tuberculosis not only increased screening and identification of people with latent tuberculosis, but also increased identification of those with active tuberculosis. In this randomized clinical trial, screening was 0.4% and 57% in the nonintervention and intervention groups respectively, and identification of both those with latent tuberculosis infection (9% to 19%) and those with active tuberculosis (34% v. 47%) increased.…”

mentioning

confidence: 99%

Tuberculosis: evidence review for newly arriving immigrants and refugees

Greenaway

Sandoe²,

Vissandjée³

et al. 2010

Canadian Medical Association Journal

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The casesOusman, a 32-year-old man; his 8-year-old daughter, Nene; and his 65-year-old mother, Mariama, from Casamance, Senegal, speak only Wolof and arrived in Canada six months ago from a refugee camp. What, if any, screening for latent tuberculosis should be done for this family?Active pulmonary tuberculosis was recently diagnosed in Harjit, a 65-year-old man who immigrated to Canada from India at age 32. Diabetes was diagnosed when he was 40 years old, and chronic renal failure developed one year ago that required dialysis because of the diabetes. Should screening for latent tuberculosis have been done for this man, and if so when?

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“…There are still considerable delays in the recognition and treatment of TB globally (most studies report a total diagnostic delay ranging between 60-90 days) with contributions from both patient and healthcare provider delays. 7 Thus, there is still a need to raise awareness of TB within primary care to help tackle diagnostic delay and its contribution to the TB epidemic.…”

Section: Raising Awareness and Tb Screening In Primary Carementioning

confidence: 99%