The Tuberculosis Clinic: Results

From 1978 to 1987, 290 episodes of tuberculosis in 260 patients were identified. Excluded from the study were six who had not completed therapy by the beginning of 1987, 34 whose treatment started before 1978, 65 who either died in the hospital or were referred to another treatment source after discharge from the hospital, and one whose medical record was not available. Of the 184 episodes in 168 remaining patients, 104 were followed up in the general clinics and 80 were followed up in the tuberculosis clinic. Except for two patients, those followed up in the general clinics developed disease from 1977 to 1982 and those in the tuberculosis clinic developed disease from 1982 to 1986. Men outnumbered women 182 to 2. Twenty-one of the general clinic group and 45 of the tuberculosis clinic group were documented alcohol abusers. There were nine patients in the general clinics group (10 percent) and seven in the tuberculosis clinic group (9 percent) who were treated for tuberculosis a second time. The results, after excluding the repeat episodes, were similar to those obtained from analyzing all episodes so the numbers reported are the total episodes of tuberculosis treated.

There were significant differences between the groups both for treatment completion and follow-up. Table 1 shows that only 12 percent of the general clinic group had documented completion of treatment with an effective regimen compared with 86 percent of patients in the tuberculosis clinic group. The general clinic group had 64 percent whose treatment completion was not documented, 6 percent who received incomplete treatment, and 11 percent who had no documentation of tuberculosis treatment. The tuberculosis clinic group had no patients in these categories. Eleven percent of patients from the tuberculosis clinic group and 3 percent from the general clinic group were referred or died from nontuberculous causes during outpatient treatment. Both groups had two patients who refused treatment. The tuberculosis clinic patients were referred to the Board of Health, but the general clinic patients were not. All patients in the tuberculosis group with sensitive organisms were initially treated with isoniazid and rifampin, whereas many patients in the general clinics were treated with the older standard regimens of isoniazid and ethambutol.
Table 2 shows that all the tuberculosis clinic patients had completely documented follow-up compared with 31 percent by the general clinic group. Sixty-four percent of the general clinic group had incompletely documented follow-up, 3 percent were unavailable for follow-up before completing treatment, and 2 percent were never seen for tuberculosis as an outpatient despite being given a clinic appointment. The tuberculosis clinic group had no case in these categories. The analysis by treatment regimen (Tables 3 to 6) showed no important difference from the results of all patients considered together (Tables 1 and 2).
The logistic regression showed that clinic alone was the only predictor of completed therapy. The chi square value for clinic was 26; the partial r value was 0.31; and the p value was less than 0.0001. The chi square values from the other variables, alcohol abuse, treatment regimen, and year of diagnosis were less than 1; their partial r values were less than 0.001; and the p values were greater than 0.35.
Table 1—Percentage of Outpatients Having Documented Treatment for Tuberculosis

Tuberculosis Clinic (n = 80) General Clinics (n = 104) P Value
Completely documented effective treatment* 86 12 <0.0001
Incomplete treatment 0 6 <0.04
No treatment given 0 2 NS
Treatment completion not documented 0 64 <0.0001
No documentation of any treatment 0 11 <0.001
Referred or died during treatment 11 3 <0.02
Refused treatmentt 3 2 NS

Table 2—Percentage of Outpatient* Having Documented FbQow-upfor Tuberculosis

Tuberculosis Clinic (n = 80) General Clinics (n = 104) P Value
Completely documented follow-up 100 31 <0.0001
Complete follow-up not documented 0 64 <0.0001
Unavailable for follow-up 0 3 NS
Not seen for tuberculosis as outpatient 0 2 NS

Table 3- Percentage of Outpatients Having Documented Treatment for Tuberculosis in the Group Receiving Rifampin and Isoniazid

TuberculosisClinic

(n=45)

General Clinics (n = 77) P Value
Completely documented effective treatment* 87 13 <0.0001
Incomplete treatment* 0 4 NS
Treatment completion not documented 0 78 <0.0001
No documentation of any treatment 0 0 NS
Referred or died during treatment 10 4 NS
Refused treatmentf 3 0 NS

Table 4—Percentage of Outpatients Having Documented FoQow-upfor Tuberculosis in the Group Receiving Rifampin and Isoniazid

TuberculosisClinic

(n=45)

General Clinic (n = 77) P Value
Complete follow-up documented 100 36 <0.0001
Complete follow-up not documented 0 62 <0.0001
Unavailable for follow-up 0 2 NS
Not seen for tuberculosis as outpatient 0 0 NS

Table 5—Percentage of Outpatients Having Documented Treatment for Tuberculosis in the Group Not Receiving Rifampin and Isoniazid

TuberculosisClinic

(n=3)

GeneralClinics

(n=59)

P Value
Completely documented effective treatment* 67 12 <0.05
Incomplete treatment* 0 7 NS
No treatment given 0 3 NS
Treatment completion not documented 0 52 NS
No documentation of any treatment 0 20 NS
Referred or died during treatment 33 2 NS
Refused treatment! 0 3 NS

Table 6—Percentage of Outpatients Having Documented Follow-up for Tuberculosis in the Group Not Receiving Rifampin and Isoniazid

TuberculosisClinic

(n-3)

General Clinic (n = 60) P Value
Complete follow-up documented 100 27 <0.03
Complete follow-up not documented 0 66 <0.05
Unavailable for follow-up 0 3 NS
Not seen for tuberculosis as outpatient 0 3 NS

Category: Tuberculosis

Tags: outpatient, pulmonary, Treatment, tuberculosis