Diagnostic pathways and delay among tuberculosis patients in Stockholm, Sweden: a retrospective observational study
Abstract Background Asylum seekers in Sweden are offered tuberculosis (TB) screening at a voluntary post-arrival health examination. The role of this screening in improving the TB diagnostic pathway has not been previously evaluated. The aim of this study was to determine diagnostic pathways for act...
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| Format: | Article |
| Language: | English |
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BMC
2019-02-01
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| Series: | BMC Public Health |
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| Online Access: | http://link.springer.com/article/10.1186/s12889-019-6462-5 |
| _version_ | 1811306505394192384 |
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| author | Anna Wikell Helena Åberg Jad Shedrawy Isac Röhl Jerker Jonsson Ingela Berggren Charlotte Buxbaum Knut Lönnroth Judith Bruchfeld |
| author_facet | Anna Wikell Helena Åberg Jad Shedrawy Isac Röhl Jerker Jonsson Ingela Berggren Charlotte Buxbaum Knut Lönnroth Judith Bruchfeld |
| author_sort | Anna Wikell |
| collection | DOAJ |
| description | Abstract Background Asylum seekers in Sweden are offered tuberculosis (TB) screening at a voluntary post-arrival health examination. The role of this screening in improving the TB diagnostic pathway has not been previously evaluated. The aim of this study was to determine diagnostic pathways for active TB cases and compare diagnostic delays between different pathways. Methods Retrospective review of medical records of patients reported with active TB in Stockholm in 2015, using a structured and pre-coded form. Results Seventy-one percent of patients actively sought health care due to symptoms. As for source of referral to TB specialist clinic, 15% came from screening of eligible migrants, of whom the majority were asymptomatic. Among asylum seekers, 69% were identified through screening at a health examination (HE). The main sources of referral to TB clinics were emergency departments (27%) and primary health care centers (20%). Median health care provider delay was significantly longer in patients identified through migrant screening in health examination. Conclusions Screening at a health examination was the main pathway of active TB detection among mainly asymptomatic and non-contagious asylum seekers but contributed modestly to total overall TB case detection. In these patients TB was diagnosed early in a non-contagious phase of the disease. Further research is required to assess the effectiveness and cost-effectiveness of HE TB screening as well as inclusion of other groups of migrants from high incidence countries in the screening program in terms of impact on delay, transmission and treatment outcomes. |
| first_indexed | 2024-04-13T08:45:50Z |
| format | Article |
| id | doaj.art-a51ae3b269f946799416307f69daa2d5 |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-04-13T08:45:50Z |
| publishDate | 2019-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-a51ae3b269f946799416307f69daa2d52022-12-22T02:53:40ZengBMCBMC Public Health1471-24582019-02-0119111010.1186/s12889-019-6462-5Diagnostic pathways and delay among tuberculosis patients in Stockholm, Sweden: a retrospective observational studyAnna Wikell0Helena Åberg1Jad Shedrawy2Isac Röhl3Jerker Jonsson4Ingela Berggren5Charlotte Buxbaum6Knut Lönnroth7Judith Bruchfeld8Division of Infectious Diseases, Department of Medicine, Karolinska InstitutetDivision of Infectious Diseases, Department of Medicine, Karolinska InstitutetDepartment of Public Health Sciences, Karolinska InstitutetDivision of Infectious Diseases, Department of Medicine, Karolinska InstitutetDivision of Infectious Diseases, Department of Medicine, Karolinska InstitutetDepartment of Communicable Disease Control & Prevention, Stockholm County CouncilDepartment of Pediatrics, Karolinska University Hospital HuddingeDepartment of Public Health Sciences, Karolinska InstitutetDivision of Infectious Diseases, Department of Medicine, Karolinska InstitutetAbstract Background Asylum seekers in Sweden are offered tuberculosis (TB) screening at a voluntary post-arrival health examination. The role of this screening in improving the TB diagnostic pathway has not been previously evaluated. The aim of this study was to determine diagnostic pathways for active TB cases and compare diagnostic delays between different pathways. Methods Retrospective review of medical records of patients reported with active TB in Stockholm in 2015, using a structured and pre-coded form. Results Seventy-one percent of patients actively sought health care due to symptoms. As for source of referral to TB specialist clinic, 15% came from screening of eligible migrants, of whom the majority were asymptomatic. Among asylum seekers, 69% were identified through screening at a health examination (HE). The main sources of referral to TB clinics were emergency departments (27%) and primary health care centers (20%). Median health care provider delay was significantly longer in patients identified through migrant screening in health examination. Conclusions Screening at a health examination was the main pathway of active TB detection among mainly asymptomatic and non-contagious asylum seekers but contributed modestly to total overall TB case detection. In these patients TB was diagnosed early in a non-contagious phase of the disease. Further research is required to assess the effectiveness and cost-effectiveness of HE TB screening as well as inclusion of other groups of migrants from high incidence countries in the screening program in terms of impact on delay, transmission and treatment outcomes.http://link.springer.com/article/10.1186/s12889-019-6462-5Asylum seekersDiagnostic delayHealth examinationScreeningTuberculosis |
| spellingShingle | Anna Wikell Helena Åberg Jad Shedrawy Isac Röhl Jerker Jonsson Ingela Berggren Charlotte Buxbaum Knut Lönnroth Judith Bruchfeld Diagnostic pathways and delay among tuberculosis patients in Stockholm, Sweden: a retrospective observational study BMC Public Health Asylum seekers Diagnostic delay Health examination Screening Tuberculosis |
| title | Diagnostic pathways and delay among tuberculosis patients in Stockholm, Sweden: a retrospective observational study |
| title_full | Diagnostic pathways and delay among tuberculosis patients in Stockholm, Sweden: a retrospective observational study |
| title_fullStr | Diagnostic pathways and delay among tuberculosis patients in Stockholm, Sweden: a retrospective observational study |
| title_full_unstemmed | Diagnostic pathways and delay among tuberculosis patients in Stockholm, Sweden: a retrospective observational study |
| title_short | Diagnostic pathways and delay among tuberculosis patients in Stockholm, Sweden: a retrospective observational study |
| title_sort | diagnostic pathways and delay among tuberculosis patients in stockholm sweden a retrospective observational study |
| topic | Asylum seekers Diagnostic delay Health examination Screening Tuberculosis |
| url | http://link.springer.com/article/10.1186/s12889-019-6462-5 |
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