A clinical audit and cost analysis of latent TB management at a tertiary referral centre in Ireland
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ORIGINAL ARTICLE
A clinical audit and cost analysis of latent TB management at a tertiary referral centre in Ireland James O’Connell 1 & Joy Oguntuase 2 & Samuel McConkey 1,3 & Eoghan de Barra 1,3 Received: 31 January 2020 / Accepted: 5 March 2020 # Royal Academy of Medicine in Ireland 2020
Abstract Introduction It is estimated that 24.8% of the world’s population has latent TB. The World Health Organization’s (WHO) End TB Strategy states that the systematic identification and management of LTBI in groups of people at high risk of reactivation is an essential part of TB elimination in low-incidence countries. Aim Our aims were to evaluate the effectiveness of LTBI management at our tertiary referral outpatient department (OPD) and to identify how our service could be improved. Methods We included all patients seen in the infectious diseases outpatient service who were referred querying a diagnosis of latent TB. Patients had to have attended the outpatient clinic at least once in the 6 months from 1 July 2018 to 31 December 2018. Patients who were referred for assessment of possible active TB were not included in. A retrospective review of each patient’s electronic record was performed by two auditors. Results Twenty-five patients reviewed in our TB clinic were referred querying a diagnosis of LTBI. Twenty-two of 25 (88%) were diagnosed with LTBI; 21/25 (84%) were offered treatment. All patients offered treatment accepted treatment. Seventeen of 21 (81%) patients completed treatment. The mean cost per patient seen in the clinic was €1378.66. The mean cost per LTBI successfully treated was €2027.45. No patient had a raised ALT detected. There were no other adverse events. Conclusion Our TB clinic is effective in the assessment and safe management of latent TB in accordance with national guidelines. Interventions for improvement are the creation of referral guidelines and a referral proforma and exploring alternative clinic models. Keywords Cost . Outpatient . Tuberculosis
Introduction Latent tuberculosis infection (LTBI) is a state of persistent immune response to stimulation by Mycobacterium
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11845-020-02209-3) contains supplementary material, which is available to authorized users. * James O’Connell [email protected] 1
Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Beaux Lane House, Mercer Street Lower, Dublin 2, Dublin, Ireland
2
Royal College of Surgeons in Ireland, Dublin, Ireland
3
Department of Infectious Diseases, Beaumont Hospital, RCSI Hospital Group, Dublin, Ireland
tuberculosis antigens with no evidence of clinically manifest active TB [1]. It is estimated that 24.8% of the world’s population has LTBI [2]. The World Health Organization’s (WHO) End TB Strategy states that the systematic identification and management of LTBI in groups of people at high risk of reactivation is an essential part of TB elimination in low-incidence countries [3]. The incid
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