Regional survey of tuberculosis risk assessment in rheumatology outpatients commencing anti-TNF-α treatment in relation to British Thoracic Society guidelines
| Autor: | Christopher D. Buckley, Karen Obrenovic, Nicola Erb, L Koh, I. F. Rowe, Holly John |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2009 |
| Předmět: |
medicine.medical_specialty
Tuberculosis Antitubercular Agents Opportunistic Infections Ambulatory Care Facilities Chemoprevention Risk Assessment Respiratory examination Arthritis Rheumatoid Tuberculosis diagnosis Risk Factors Internal medicine medicine Humans Risk factor Practice Patterns Physicians' Referral and Consultation Retrospective Studies business.industry Tuberculin Test Tumor Necrosis Factor-alpha Retrospective cohort study General Medicine medicine.disease Original Papers Surgery England Antirheumatic Agents Chemoprophylaxis Ambulatory Practice Guidelines as Topic business Risk assessment |
| Popis: | The aim of this study was to analyse tuberculosis (TB) risk assessment for rheumatology patients commencing anti-tumour necrosis factor-alpha (anti-TNF-alpha) therapy using the British Thoracic Society (BTS) guidelines. Data were obtained retrospectively on 856 outpatients regionally receiving anti-TNF-alpha. Prior to commencing treatment, patients had the following assessments documented: respiratory examination, 47.4%; chest X-ray, 84.5%; TB history, 92.9%; and advice about TB risk, 45.8%. Of the 856 patients, 94.3% were on immunosuppressives but 27% had a tuberculin test; 12.6% had > or =1 high-risk factors for TB. In total, 3.4% were referred to a TB specialist and of these, 24.1% had no risk factors for TB. Of patients with > or =1 risk factor, 76.9% were not referred. Only 4/28 patients at high risk for TB due to ethnicity or birthplace received chemoprophylaxis. Marked inter-unit variation was demonstrated and it was evident that patients require improved screening for TB. Greater awareness is necessary of patients with risk factors, particularly ethnicity, to facilitate more appropriate targeting of chemoprophylaxis. Multi-centre audit is a valuable clinical governance tool. |
| Databáze: | OpenAIRE |
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