Evaluation of safety tool for ambulatory leprosy patients at risk of adverse outcome.

Autor: MacRae C; 1University of Toronto, Toronto, ON Canada., Kopalakrishnan S; 1University of Toronto, Toronto, ON Canada., Faust L; 1University of Toronto, Toronto, ON Canada., Klowak M; 2McMaster University, Hamilton, ON Canada., Showler A; 3Georgetown University, Washington, DC USA., Klowak SA; 4Tropical Disease Unit, Toronto General Hospital, 200 Elizabeth Street, 13-EN218, Toronto, ON M5G 2C4 Canada., Boggild AK; 4Tropical Disease Unit, Toronto General Hospital, 200 Elizabeth Street, 13-EN218, Toronto, ON M5G 2C4 Canada.; 5Department of Medicine, University of Toronto, Toronto, Canada.; 6Public Health Ontario Laboratories, Toronto, Canada.
Jazyk: angličtina
Zdroj: Tropical diseases, travel medicine and vaccines [Trop Dis Travel Med Vaccines] 2018 Mar 02; Vol. 4, pp. 1. Date of Electronic Publication: 2018 Mar 02 (Print Publication: 2018).
DOI: 10.1186/s40794-018-0061-9
Abstrakt: Background: Leprosy is a potentially debilitating disease of the skin and nerves that requires a complex management approach consisting of laboratory monitoring, screening for factors that will adversely affect outcome with corticosteroids, engagement of allied health services, and prolonged follow-up. Given the complexities of leprosy management, a safety tool was developed and implemented in the Tropical Disease Unit at Toronto General Hospital. Our objective was to evaluate the utility of the tool using a retrospective chart review.
Methods: We reviewed the charts of patients with leprosy treated over a 3.5-year period: up to 3 years prior to tool implementation, and 6-months following implementation. Pre-determined outcomes of interest included: loss to follow-up; monitoring of laboratory parameters; allied health services engagement; baseline ophthalmologic assessment; and risk mitigation interventions.
Results: Of 17 patients enrolled, 8 were treated pre-implementation, and 9 post-implementation. Five (29.4%) pre-implementation patients were lost to follow-up compared to none post-implementation ( p  = 0.009). One (12.5%) pre-implementation patient was sent for baseline ophthalmologic assessment versus 8 (88.9%) post-implementation ( p  = 0.0034). Only post-implementation patients received referrals for occupational therapy and social work, with 77.8% ( n  = 7) receiving occupational therapy ( p  = 0.0023) and 33.3% ( n  = 3) social work ( p  = 0.2059). Laboratory parameters such as hemoglobin, hepatic transaminases, and methemoglobin were routinely monitored for patients on dapsone irrespective of tool implementation.
Conclusions: Implementation of a leprosy-specific safety tool has established a user-friendly method for systemizing all elements of care, and ensuring the involvement of allied health services necessary for optimizing health outcomes.
Competing Interests: The study protocol and data collection form were approved by the University Health Network Research Ethics Board (Toronto, Canada).Not applicable.None of the authors have conflicts of interest to disclose.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Databáze: MEDLINE
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