Abstract
BackgroundAbout 90% of new tuberculosis (TB) cases in Norway appear among immigrants from high incidence countries. There is a compulsory governmental tuberculosis screening programme for immigrants; immigrants with positive screening results are to be referred from municipal health care to the specialist health care for follow-up. Recent studies of the screening programme have shown inadequate follow-up. One of the main problems has been that patients referred for follow-up have not attended their appointment at the specialist health care.TB screening in the municipality of Trondheim is done by two different teams: the Refugee Healthcare Centre (RHC) screens refugees and the Vaccination and Infection Control Office (VICO) screens all the other groups. Patients with positive findings on screening are referred to the hospital’s Pulmonary Out-patient Department (POPD). The municipal and referral level public health care initiated a project aiming to improve follow-up through closer collaboration.MethodsAn intervention group and a pre-intervention control group were established for each screening group. During meetings between staff from the municipality and the POPD, inadequacies in the screening process were identified, and changes in procedures for summoning patients, and time and place for tests were implemented. For both the intervention group and the control group, time from referral until consultation at the POPD and number of patients that attended their first appointment were registered and compared.ResultsIn the VICO group, 97/134 (72%) of the controls and 109/123 (89%) of the intervention group attended their first appointment at the POPD after 30 weeks (median) and 10 weeks, respectively. In the RHC group 28/46 (61%) of the controls and 55/59 (93%) in the intervention group attended their first appointment after 15 and 8 weeks (median) respectively.ConclusionIncreased collaboration between the municipal and specialist health care can improve the follow-up of positive TB screening results.
Highlights
About 90% of new tuberculosis (TB) cases in Norway appear among immigrants from high incidence countries
Asylum seekers not suspected of TB disease are transferred to other centres in Norway where the municipal public health care is to follow-up the screening results
The public health care dealing with tuberculosis is organized in two different teams: the Vaccination and Infection Control Office (VICO) and the Refugee Healthcare Centre (RHC)
Summary
About 90% of new tuberculosis (TB) cases in Norway appear among immigrants from high incidence countries. There is a compulsory governmental tuberculosis screening programme for immigrants; immigrants with positive screening results are to be referred from municipal health care to the specialist health care for follow-up. Asylum seekers not suspected of TB disease are transferred to other centres in Norway where the municipal public health care is to follow-up the screening results. E.g. refugees, labour immigrants, students, family reunions, healthcare and childcare staff after returning from high incidence countries, and participants in contact tracing, are screened by the public health care in the municipality where they are living. When an abnormal Xray, a Mantoux test ≥ 15 mm or a positive IGRA test is detected, the patient is referred to the local hospital, the department of pulmonary medicine, the department of pediatrics, or the department of infectious diseases. Active TB is diagnosed by a combination of clinical examinations, tests for mycobacteria and radiology
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