Archive for the ‘Tuberculosis’ Category

The Tuberculosis Clinic: conclusion

The experience in this clinic, like that in developing countries and in recalcitrant patients, was highly successful in treating tuberculosis. In the general clinics, physicians only rarely used incorrect drug combinations. The problem was inconsistent follow-up and insufficient attention to compliance. These problems were solved more effectively at our medical center by nurse specialists than physicians. This has been reported by others in tuberculosis care. Another benefit of a specialized clinic may be saving the costs of retreatment. Although it is obvious that avoiding retreatment is important, estimation of its cost-effectiveness is difficult because it depends on the nature and infectivity of the patient with recurrence. In the tuberculosis clinic, about 9 percent of the patients were seen for repeated episodes of tuberculosis. Read the rest of this entry »

The Tuberculosis Clinic: Discussion

The Tuberculosis Clinic: DiscussionThis study was an attempt to compare the compliance aspects of the treatment and care of patients with tuberculosis in a specialty clinic with their treatment and care in general clinics in a teaching hospital. Although not a randomized prospective trial we felt there may be important lessons for those caring for patients with tuberculosis. We anticipated that more outpatients from the tuberculosis clinic than from the general clinics would have documentation of successful treatment, but we were surprised to learn that more than half (64 percent) of the records of the general clinics were incomplete. Most records showed neither the Start and stop dates of the medications nor evidence of compliance. The content of the progress notes varied with physicians and clinics. Failed appointments were frequent. Laboratory reports of sputum growth of M tuberculosis went unnoticed. The notation “chart unavailable” frequently appeared in the progress note, making it difficult for physicians to document progress. Read the rest of this entry »

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. Read the rest of this entry »

The Tuberculosis Clinic: Methods

The Tuberculosis Clinic: MethodsMethods
The medical records from 1978 to 1987 for all patients with a documented diagnosis of pulmonary tuberculosis were reviewed. The diagnosis was made by either a report from the laboratory of Mycobacterium tuberculosis growing in culture or a physicians note of a positive sputum smear or culture. The following were compiled from the medical record: the year of diagnosis, the presence of alcohol abuse, the completion of treatment, the drugs given and whether the regimen followed American Thoracic Society guidelines, the follow-up, whether the patient was alive at the end of treatment, and whether the patient was referred to a treatment source outside of the medical center. Read the rest of this entry »

The Tuberculosis Clinic: Outpatients

The patients were evaluated initially by a pulmonary fellow and the clinic attending pulmonary physician and thereafter monthly by the same nurse specialist. The pulmonologist saw all patients to start, stop or change therapy, to review radiographs and abnormal clinical data and to evaluate other medical problems. Documentation was standardized by use of printed progress notes. Patients who missed their appointments were called that day and rescheduled for the following clinic day. All patients who refused treatment or who defaulted were promptly referred to the Board of Health for follow-up. Read the rest of this entry »

The Tuberculosis Clinic

The Tuberculosis ClinicTreatment of tuberculosis is more than 95 percent effective for patients who complete a course of medication as recommended by the American Thoracic Society. However, success often is not attained because of patient noncompliance which is the greatest obstacle to the successful treatment and elimination of tuberculosis. At our medical center, treatment of patients with tuberculosis has been carried out in the general outpatient clinics, often in the clinic where patients were followed up for other medical problems. In this setting, the clinic physician chose the type and duration of antituberculosis medication, the frequency of return appointments, and length of follow-up. Several problems with this treatment method recurred. Patients were not seen by the same physician at each clinic visit. Patient records were not always available. A mechanism did not exist for contacting patients who missed appointments. Patients who defaulted from treatment were not identified or referred to the Board of Health. Here
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