Impact of policy and practice on the effectiveness of contact screening for tuberculosis
Impact of policy and practice on the effectiveness of contact screening for tuberculosis
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DOI：
10.1006/pmed.1998.0366
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发表时间：
1998-11-01
影响因子：
5.1
通讯作者：
Plant, AJ
中科院分区：
文献类型：
--
作者：
MacIntyre, CR;Plant, AJ
背景进行结核病筛查是因为结核病是一种具有公共卫生重要性的疾病，如果在筛查后对感染者进行异烟肼预防，就可以预防结核病。只有合理和系统地进行筛查，并在适当情况下进行预防，才能有效地进行筛查。我们的目的是考虑结核病接触者筛查指南是否是以证据为基础的和适当的，这些指南的实施情况如何，以及政策和实践对预防的影响。对1991年在澳大利亚维多利亚筛选的1，142名最近接触者的队列进行了研究。我们评估了筛查指南的适当性，以及它们的实施情况，以及这两个因素的结合如何影响筛查计划的有效性。筛查指南需要更新，而且没有证据。胸片（CXR）被过度使用，是近40%（449/1，142）接触者的唯一筛查工具。80%的重复CXR是在正常的初始研究后进行的。皮肤测试未得到充分利用。在近60%（658/1，142）的所有接触者中，无法确定是否存在感染，因为没有进行皮肤试验，并且CXR（如果进行）是明确的。只有22%（38/175）的确定，合格的接触者接受了异烟肼预防性治疗。缺乏循证指南，以及对指南的坚持性差，导致了一个效率低下的计划。这个问题可能不是唯一的研究设置，但不能确定没有系统的程序评估，我们提供了一个模型。(C)1998年美国健康基金会和学术出版社。
Background Screening for tuberculosis is conducted because TB is a disease of public health importance that can be prevented if screening is followed by isoniazid prophylaxis for infected individuals. Screening alone is not effective unless that screening is rational and systematic and is followed by prevention where appropriate. Our aim was to consider whether the TB contact screening guidelines are evidence-based and appropriate, how well these guidelines are implemented, and how policy and practice impact on prevention.Methods. A cohort of 1,142 recent contacts screened in 1991 in Victoria, Australia, was studied. We evaluated the appropriateness of the screening guidelines and how well they were implemented and how the combination of these two factors impacted on the efficacy of the screening program.Results. The screening guidelines required updating and were not evidence-based. Chest radiograph (CXR) was overused and was the sole screening tool for nearly 40% (449/1,142) of contacts. Eighty percent of repeat CXRs were done following a normal initial study. Skin testing was underused. In nearly 60% (658/1,142) of all contacts, the presence or absence of infection could not be determined because a skin test was not done and the CXR, if done, was clear. Only 22% (38/175) of identified, eligible contacts received isoniazid preventive therapy.Conclusions. Lack of evidence-based guidelines, as well as poor adherence to guidelines, resulted in an inefficient program. This problem may not be unique to the study setting, but cannot be identified without systematic program evaluation, for which we have provided a model. (C) 1998 American Health Foundation and Academic Press.