Challenges in LTBI care in the United States identified using a nationwide TB medical consultation database.

IF 1.3 Q4 RESPIRATORY SYSTEM Public Health Action Pub Date : 2021-09-21 DOI:10.5588/pha.21.0026

N T Agathis, R Bhavaraju, V Shah, L Chen, C A Haley, N D Goswami, A Patrawalla

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Abstract

Background: Identifying and treating individuals with latent TB infection (LTBI) represents a critical and challenging component of national TB elimination. Medical consultations by the Centers for Disease Control and Prevention (CDC) funded TB Centers of Excellence (COEs) are an important resource for healthcare professionals (HCPs) caring for individuals with LTBI. This study aimed to identify the most common clinical concerns regarding LTBI care and to describe epidemiologic and clinical features of patients discussed in these consultations.

Methods: This mixed-methods study randomly sampled 125 consultation inquiries related to LTBI from the COEs' medical consultation database in 2018. Text from consultation records were reviewed and coded to identify reasons for the inquiries and common epidemiologic and clinical patient characteristics.

Results: The most common topics of inquiry for consultation included accurate LTBI diagnosis (36%), management of LTBI treatment-related issues (22%), and choice of appropriate LTBI treatment regimen (17%). Patients for whom consultations were requested commonly had another medical condition (34%), were non-U.S. born (31%), were children (25%), and had a history of travel to TB-endemic areas (18%).

Conclusion: Our findings emphasize the challenge of managing patients with either suspected or confirmed LTBI, highlighting the need for ongoing medical consultation support for nuanced clinical and epidemiologic scenarios.

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使用全国结核病医疗咨询数据库确定美国LTBI护理面临的挑战。

背景:识别和治疗潜伏性结核感染(LTBI)个体是国家消除结核病的关键和具有挑战性的组成部分。由疾病控制和预防中心(CDC)资助的结核病卓越中心(coe)提供的医疗咨询是照顾LTBI患者的医疗保健专业人员(hcp)的重要资源。本研究旨在确定LTBI护理中最常见的临床问题，并描述这些咨询中讨论的患者的流行病学和临床特征。方法:混合方法研究随机抽取2018年COEs医疗咨询数据库中125份与LTBI相关的咨询问询。对会诊记录中的文本进行审查和编码，以确定问诊的原因以及常见的流行病学和临床患者特征。结果:咨询最常见的问题包括准确的LTBI诊断(36%)、LTBI治疗相关问题的管理(22%)和选择合适的LTBI治疗方案(17%)。被要求咨询的患者通常有其他疾病(34%)，非美国人。出生(31%)，是儿童(25%)，有结核病流行地区旅行史(18%)。结论:我们的研究结果强调了管理疑似或确诊LTBI患者的挑战，强调了对细微的临床和流行病学情况进行持续医疗咨询支持的必要性。

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Public Health Action RESPIRATORY SYSTEM-

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期刊介绍： Launched on 1 May 2011, Public Health Action (PHA) is an official publication of the International Union Against Tuberculosis and Lung Disease (The Union). It is an open access, online journal available world-wide to physicians, health workers, researchers, professors, students and decision-makers, including public health centres, medical, university and pharmaceutical libraries, hospitals, clinics, foundations and institutions. PHA is a peer-reviewed scholarly journal that actively encourages, communicates and reports new knowledge, dialogue and controversy in health systems and services for people in vulnerable and resource-limited communities — all topics that reflect the mission of The Union, Health solutions for the poor.