Abstract
BackgroundPatients with TB have diverse and often challenging clinical and social needs that may hamper successful treatment outcomes. Understanding the need for additional support during treatment (enhanced case management, or ECM) is important for workforce capacity planning. North West England TB Cohort Audit (TBCA) has introduced a 4-level ECM classification system (ECM 0–3) to quantify the need for ECM in the region. This study describes the data from the first 2 years of ECM classification.MethodsData collected between April 2013 and July 2015 were used to analyse the proportions of patients allocated to each ECM level and the prevalence of social and clinical factors indicating need for ECM. Single variable and multivariable logistic regression models were constructed to examine the association between ECM level and treatment outcome.ResultsOf 1714 notified cases 99.8% were assigned an ECM level: 31% ECM1, 19% ECM2 and 14% ECM3. The most common factors indicating need for ECM were language barriers (20.3%) and clinical complexity (16.9%). 1342/1493 (89.9%) of drug-sensitive, non-CNS cases completed treatment within 12 months. Patients in ECM2 and 3 were less likely to complete treatment at 12 months than patients in ECM0 (adjusted OR 0.47 [95% CI 0.27–0.84] and 0.23 [0.13–0.41] respectively).ConclusionsUse of TBCA to quantify different levels of need for ECM is feasible and has demonstrated that social and clinical complexity is common in the region. Results will inform regional workforce planning and assist development of innovative methods to improve treatment outcomes in these vulnerable groups.
Highlights
Patients with TB have diverse and often challenging clinical and social needs that may hamper successful treatment outcomes
Risk factors for Enhanced Case Management are evaluated by TB nurses at the beginning of treatment to establish the level of support the patient will require from the multidisciplinary team and the ECM level is formalised and agreed at the time of TB Cohort Audit (TBCA)
The population During the study period, there were 1714 TB cases reviewed at TBCA of whom 1711 (99.8%) had been assigned an ECM level and were included in the analysis
Summary
Patients with TB have diverse and often challenging clinical and social needs that may hamper successful treatment outcomes. In England TB incidence has declined by one third over the past 4 years to a rate of 10.5 per 100,000 [2]. Despite this reduction the TB notification rate in England remains higher than in most other Western European countries [3] and more than three times higher than in the USA [4]. In the North West of England, overall TB notification rates are relatively low (7.9 per 100,000 in 2015), rates are high in urban centres such as Manchester (27 per 100,000 3 year average 2013–2015) [2]
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