Health professionals’ experiences of tuberculosis cohort audit in the North West of England: a qualitative study

Abstract

ObjectivesTuberculosis cohort audit (TBCA) was introduced across the North West (NW) of England in 2012 as an ongoing, multidisciplinary, systematic case review process, designed to improve clinical and public health practice. TBCA has not previously been introduced across such a large and socioeconomically diverse area in England, nor has it undergone formal, qualitative evaluation. This study explored health professionals’ experiences of the process after 1515 cases had been reviewed.DesignQualitative study using semistructured interviews. Respondents were purposively sampled from 3 groups involved in the NW TBCA: (1) TB nurse specialists, (2) consultant physicians and (3) public health practitioners. Data from the 26 respondents were triangulated with further interviews with key informants from the TBCA Steering Group and through observation of TBCA meetings.AnalysisInterview transcripts were analysed thematically using the framework approach.ResultsParticipants described the evolution of a valuable ‘community of practice’ where interprofessional exchange of experience and ideas has led to enhanced mutual respect between different roles and a shared sense of purpose. This multidisciplinary, regional approach to TB cohort audit has promoted local and regional team working, exchange of good practices and local initiatives to improve care. There is strong ownership of the process from public health professionals, nurses and clinicians; all groups want it to continue. TBCA is regarded as a tool for quality improvement that improves patient safety.ConclusionsTBCA provides peer support and learning for management of a relatively rare, but important infectious disease through discussion in a no-blame atmosphere. It is seen as an effective quality improvement strategy which enhances TB care, control and patient safety. Continuing success will require increased engagement of consultant physicians and public health practitioners, a secure and ongoing funding stream and establishment of clear reporting mechanisms within the public health system.

A cross-sectional survey of the knowledge, attitudes and practices regarding tuberculosis among general practitioners working in municipalities with and without asylum centres in eastern Norway

“…In the UK, TB cohort audit (TBCA) has been recommended in the National Institute for Health and Care Excellence (NICE) guidance since 2012 [33]. TBCA has been used as a tool in order to strengthen cross-professional collaboration and health professionals have reported changes in their practice and enhanced understanding of the different roles of the stakeholders involved in TB care [34].…”

The aims and effectiveness of communities of practice in healthcare: A systematic review

“…The most common frequent country that the studies were published in was Canada with 12 studies [ 7 , 16 , 19 , 35 , 38 , 40 , 41 , 43 , 45 , 47 , 54 , 56 ], followed closely by the USA with 10 studies [ 9 , 10 , 14 , 17 , 23 – 25 , 48 , 51 , 55 ], and the UK with 8 studies [ 8 , 12 , 13 , 15 , 18 , 22 , 31 , 37 ]. Other notable contributions came from Australia with 6 studies [ 26 , 29 , 33 , 34 , 44 , 50 ] and Spain with 4 studies [ 20 , 27 , 39 , 42 ].…”

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

“…In addition, TBCA provides a forum for open discussion of the management of individual TB cases, for obtaining peer support on the management of complex cases, such as those with multiple drug resistance (MDR) or non-adherence, for identification of systemic issues and for further education of staff in TB management and control. TBCA has been very well received by staff in the North West of England where staff have described TBCA as a valuable “community of practice” that has led to mutual respect and a shared sense of purpose between staff from different disciplines [ 13 ].…”