Development of a pharmacist-managed latent tuberculosis clinic

Abstract

Latent tuberculosis infection (LTBI) remains a significant health issue worldwide. According to the Centers for Disease Control and Prevention (CDC), an individual with LTBI has dormant Mycobacterium tuberculosis organisms but a negative chest radiograph and no signs or symptoms of the active disease.1 Nonadherence to LTBI therapy is as high as 50%, especially in urban areas with low-income residents.2,3 Patients who do not complete appropriate antiinfective therapy have an increased risk of developing active tuberculosis, thereby increasing the risk of spreading the disease to the general public. In Connecticut, there is a mandatory reporting structure for all LTBI cases. The Hospital of Saint Raphael is a 511-bed urban medical center. The financial department at our facility used International Classification of Diseases, 9th Revision, codes to identify patients with a positive purified protein derivative (PPD) skin test and negative chest radiograph in the adult and pediatric primary care clinics for calendar years 2004 and 2005. The pediatric population was screened for LTBI through the local school systems and referred to our hospital for pharmacotherapy management, while the adult population was screened by primary care physicians. During 2004, 69 patients (32 adults, 37 children) met the above criteria. Chart review revealed that only 16 patients (2 adults, 14 children) completed therapy. Data for 2005 were similar, with a total of 66 patients (27 adults, 39 children) identified. Of these patients, 19 (5 adults, 14 children) completed treatment. Although completion rates were low, they were still considerably better in the pediatric population due to additional follow-up by the school nurse.