Improving screening and management of latent tuberculosis infection: development and evaluation of latent tuberculosis infection primary care model
Abstract Background In Australia, demand for specialist infectious diseases services exceeds capacity to provide timely management of latent tuberculosis infection (LTBI) in areas of high refugee and asylum seeker settlement. A model for treating LTBI patients in primary care has been developed and...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-01-01
|
| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12879-021-06925-8 |
| _version_ | 1798026422164389888 |
|---|---|
| author | Marina Kunin Mark Timlin Chris Lemoh David A. Sheffield Alana Russo Shegofa Hazara Jacqueline McBride |
| author_facet | Marina Kunin Mark Timlin Chris Lemoh David A. Sheffield Alana Russo Shegofa Hazara Jacqueline McBride |
| author_sort | Marina Kunin |
| collection | DOAJ |
| description | Abstract Background In Australia, demand for specialist infectious diseases services exceeds capacity to provide timely management of latent tuberculosis infection (LTBI) in areas of high refugee and asylum seeker settlement. A model for treating LTBI patients in primary care has been developed and piloted in a refugee-focused primary health service (Monash Health Refugee Health and Wellbeing [MHRHW]) and a universal primary care clinic. This study reports on the development and evaluation of the model, focusing on the model feasibility, and barriers and enablers to its success. Methods A convergent mix-methods design was used to evaluate the model for treating LTBI patients in primary care, where a prospective cohort study of patients commencing treatment either at MHRHW or the universal primary care clinic determined the model feasibility, while focus groups with clinicians directly involved in treating these patients explored barriers and enablers to sustainability and success of the model. Results From January 2017 to April 2018, 65 patients with confirmed LTBI presented at participating clinics. Treatment was accepted by 31 (48%) patients, of whom 15(48%) were treated at MHRHW and 16 (52%) at the universal primary care clinic. The 6-months’ treatment completion rate was higher at MHRHW compared to the universal primary care clinic (14 (93%) compared to 9 (56%) respectively, p = 0.0373). Reasons for non-completion included adverse reaction, opting out and relocation. At the completion of the pilot, 15 clinicians participated in two focus groups. Clinicians identified barriers and enablers for successful LTBI management at patient, provider, organisational and clinical levels. While barriers for treatment completion and adherence were consistent across the two pilot sites, enablers, such as resources to facilitate patient education and follow-up, were available only at MHRHW. Conclusion Screening and management of LTBI patients can be achieved within the primary care setting, considerate of barriers and enablers at patient, provider, organisational and clinical levels. Upscaling of a primary care response to the management of LTBI will require supporting primary care clinics with resources to employ dedicated clinical staff for patient education, follow-up communication and monitoring medication adherence. |
| first_indexed | 2024-04-11T18:35:13Z |
| format | Article |
| id | doaj.art-3b5e275d9e304906bc328e02e5a64abd |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-04-11T18:35:13Z |
| publishDate | 2022-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-3b5e275d9e304906bc328e02e5a64abd2022-12-22T04:09:18ZengBMCBMC Infectious Diseases1471-23342022-01-0122111110.1186/s12879-021-06925-8Improving screening and management of latent tuberculosis infection: development and evaluation of latent tuberculosis infection primary care modelMarina Kunin0Mark Timlin1Chris Lemoh2David A. Sheffield3Alana Russo4Shegofa Hazara5Jacqueline McBride6Monash Health Refugee Health and Wellbeing, Monash HealthMonash Health Refugee Health and Wellbeing, Monash HealthMonash Health Refugee Health and Wellbeing, Monash HealthMonash Health Refugee Health and Wellbeing, Monash HealthMonash Health Refugee Health and Wellbeing, Monash HealthMonash Health Refugee Health and Wellbeing, Monash HealthMonash Health Refugee Health and Wellbeing, Monash HealthAbstract Background In Australia, demand for specialist infectious diseases services exceeds capacity to provide timely management of latent tuberculosis infection (LTBI) in areas of high refugee and asylum seeker settlement. A model for treating LTBI patients in primary care has been developed and piloted in a refugee-focused primary health service (Monash Health Refugee Health and Wellbeing [MHRHW]) and a universal primary care clinic. This study reports on the development and evaluation of the model, focusing on the model feasibility, and barriers and enablers to its success. Methods A convergent mix-methods design was used to evaluate the model for treating LTBI patients in primary care, where a prospective cohort study of patients commencing treatment either at MHRHW or the universal primary care clinic determined the model feasibility, while focus groups with clinicians directly involved in treating these patients explored barriers and enablers to sustainability and success of the model. Results From January 2017 to April 2018, 65 patients with confirmed LTBI presented at participating clinics. Treatment was accepted by 31 (48%) patients, of whom 15(48%) were treated at MHRHW and 16 (52%) at the universal primary care clinic. The 6-months’ treatment completion rate was higher at MHRHW compared to the universal primary care clinic (14 (93%) compared to 9 (56%) respectively, p = 0.0373). Reasons for non-completion included adverse reaction, opting out and relocation. At the completion of the pilot, 15 clinicians participated in two focus groups. Clinicians identified barriers and enablers for successful LTBI management at patient, provider, organisational and clinical levels. While barriers for treatment completion and adherence were consistent across the two pilot sites, enablers, such as resources to facilitate patient education and follow-up, were available only at MHRHW. Conclusion Screening and management of LTBI patients can be achieved within the primary care setting, considerate of barriers and enablers at patient, provider, organisational and clinical levels. Upscaling of a primary care response to the management of LTBI will require supporting primary care clinics with resources to employ dedicated clinical staff for patient education, follow-up communication and monitoring medication adherence.https://doi.org/10.1186/s12879-021-06925-8Latent tuberculosis infectionPrimary careRefugee healthCulturally and linguistically diverse populationsHealth care evaluationHealth care delivery |
| spellingShingle | Marina Kunin Mark Timlin Chris Lemoh David A. Sheffield Alana Russo Shegofa Hazara Jacqueline McBride Improving screening and management of latent tuberculosis infection: development and evaluation of latent tuberculosis infection primary care model BMC Infectious Diseases Latent tuberculosis infection Primary care Refugee health Culturally and linguistically diverse populations Health care evaluation Health care delivery |
| title | Improving screening and management of latent tuberculosis infection: development and evaluation of latent tuberculosis infection primary care model |
| title_full | Improving screening and management of latent tuberculosis infection: development and evaluation of latent tuberculosis infection primary care model |
| title_fullStr | Improving screening and management of latent tuberculosis infection: development and evaluation of latent tuberculosis infection primary care model |
| title_full_unstemmed | Improving screening and management of latent tuberculosis infection: development and evaluation of latent tuberculosis infection primary care model |
| title_short | Improving screening and management of latent tuberculosis infection: development and evaluation of latent tuberculosis infection primary care model |
| title_sort | improving screening and management of latent tuberculosis infection development and evaluation of latent tuberculosis infection primary care model |
| topic | Latent tuberculosis infection Primary care Refugee health Culturally and linguistically diverse populations Health care evaluation Health care delivery |
| url | https://doi.org/10.1186/s12879-021-06925-8 |
| work_keys_str_mv | AT marinakunin improvingscreeningandmanagementoflatenttuberculosisinfectiondevelopmentandevaluationoflatenttuberculosisinfectionprimarycaremodel AT marktimlin improvingscreeningandmanagementoflatenttuberculosisinfectiondevelopmentandevaluationoflatenttuberculosisinfectionprimarycaremodel AT chrislemoh improvingscreeningandmanagementoflatenttuberculosisinfectiondevelopmentandevaluationoflatenttuberculosisinfectionprimarycaremodel AT davidasheffield improvingscreeningandmanagementoflatenttuberculosisinfectiondevelopmentandevaluationoflatenttuberculosisinfectionprimarycaremodel AT alanarusso improvingscreeningandmanagementoflatenttuberculosisinfectiondevelopmentandevaluationoflatenttuberculosisinfectionprimarycaremodel AT shegofahazara improvingscreeningandmanagementoflatenttuberculosisinfectiondevelopmentandevaluationoflatenttuberculosisinfectionprimarycaremodel AT jacquelinemcbride improvingscreeningandmanagementoflatenttuberculosisinfectiondevelopmentandevaluationoflatenttuberculosisinfectionprimarycaremodel |