Tim Crocker-Buque, Harry Hayden, Jacqui White, Jennifer Dekoningh, Moerida Belton, Narinder Boparai, James Brown, Mike Brown, Danielle Hawley, Stefan Lozewicz, Rob Miller, Rachel Moores, Karyn Moshal, Jessica Potter, Marc Lipman
{"title":"为肺结核患者提供个性化护理:2013 年至 2021 年英国肺结核网络强化病例管理评估。","authors":"Tim Crocker-Buque, Harry Hayden, Jacqui White, Jennifer Dekoningh, Moerida Belton, Narinder Boparai, James Brown, Mike Brown, Danielle Hawley, Stefan Lozewicz, Rob Miller, Rachel Moores, Karyn Moshal, Jessica Potter, Marc Lipman","doi":"10.1177/20542704241290486","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Evaluating the outcomes of enhanced case management (ECM) for patients with tuberculosis (TB) in the North Central London TB Service (NCLTBS).</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>The NCLTBS provides care for persons diagnosed with TB across north and central London. Management involves both medical and psychosocial support, leading to the implementation ECM to provide additional non-clinical assistance to patients at risk of treatment non-completion. However, there has been limited evaluation of its outcomes.</p><p><strong>Participants: </strong>All adults with TB notified to NCLTBS between January 2013 and June 2021.</p><p><strong>Main outcome measures: </strong>Descriptive socio-economic and clinical characteristics grouped by binary ECM status (yes/no) and level (0-3). Clinical outcomes at 12 months (completed treatment, death, lost-to-follow-up, continuing on treatment) were compared using multivariable logistic regression.</p><p><strong>Results: </strong>Totally, 2437 patients were included (57.2% male, 79.1% born outside the UK). Overall, 82.3% completed treatment and 4.1% died. Factors associated with mortality included older age (over 70 years odds ratio (OR) 3.3), inpatient diagnosis (OR 4.4), and mental health issues (OR 2.2). 52.8% received ECM, with the proportion increasing over time, and 76% of this group successfully competed treatment.</p><p><strong>Conclusions: </strong>This comprehensive evaluation of ECM in a diverse London population indicates high treatment completion rates even among those with multiple social risk factors. However, ECM needs of patients has increased over time, with a particular rise in patients requiring the highest support level. Given the small difference between standard care and ECM categories 1 and 2, there may be scope to simplify the system.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"15 10","pages":"20542704241290486"},"PeriodicalIF":0.0000,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574889/pdf/","citationCount":"0","resultStr":"{\"title\":\"Providing personalised care for people with tuberculosis: an evaluation of enhanced case management in a UK TB Network 2013 to 2021.\",\"authors\":\"Tim Crocker-Buque, Harry Hayden, Jacqui White, Jennifer Dekoningh, Moerida Belton, Narinder Boparai, James Brown, Mike Brown, Danielle Hawley, Stefan Lozewicz, Rob Miller, Rachel Moores, Karyn Moshal, Jessica Potter, Marc Lipman\",\"doi\":\"10.1177/20542704241290486\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>Evaluating the outcomes of enhanced case management (ECM) for patients with tuberculosis (TB) in the North Central London TB Service (NCLTBS).</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>The NCLTBS provides care for persons diagnosed with TB across north and central London. Management involves both medical and psychosocial support, leading to the implementation ECM to provide additional non-clinical assistance to patients at risk of treatment non-completion. However, there has been limited evaluation of its outcomes.</p><p><strong>Participants: </strong>All adults with TB notified to NCLTBS between January 2013 and June 2021.</p><p><strong>Main outcome measures: </strong>Descriptive socio-economic and clinical characteristics grouped by binary ECM status (yes/no) and level (0-3). Clinical outcomes at 12 months (completed treatment, death, lost-to-follow-up, continuing on treatment) were compared using multivariable logistic regression.</p><p><strong>Results: </strong>Totally, 2437 patients were included (57.2% male, 79.1% born outside the UK). Overall, 82.3% completed treatment and 4.1% died. Factors associated with mortality included older age (over 70 years odds ratio (OR) 3.3), inpatient diagnosis (OR 4.4), and mental health issues (OR 2.2). 52.8% received ECM, with the proportion increasing over time, and 76% of this group successfully competed treatment.</p><p><strong>Conclusions: </strong>This comprehensive evaluation of ECM in a diverse London population indicates high treatment completion rates even among those with multiple social risk factors. However, ECM needs of patients has increased over time, with a particular rise in patients requiring the highest support level. Given the small difference between standard care and ECM categories 1 and 2, there may be scope to simplify the system.</p>\",\"PeriodicalId\":17674,\"journal\":{\"name\":\"JRSM Open\",\"volume\":\"15 10\",\"pages\":\"20542704241290486\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-11-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574889/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JRSM Open\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/20542704241290486\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/10/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JRSM Open","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/20542704241290486","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/10/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
Providing personalised care for people with tuberculosis: an evaluation of enhanced case management in a UK TB Network 2013 to 2021.
Objectives: Evaluating the outcomes of enhanced case management (ECM) for patients with tuberculosis (TB) in the North Central London TB Service (NCLTBS).
Design: Retrospective cohort study.
Setting: The NCLTBS provides care for persons diagnosed with TB across north and central London. Management involves both medical and psychosocial support, leading to the implementation ECM to provide additional non-clinical assistance to patients at risk of treatment non-completion. However, there has been limited evaluation of its outcomes.
Participants: All adults with TB notified to NCLTBS between January 2013 and June 2021.
Main outcome measures: Descriptive socio-economic and clinical characteristics grouped by binary ECM status (yes/no) and level (0-3). Clinical outcomes at 12 months (completed treatment, death, lost-to-follow-up, continuing on treatment) were compared using multivariable logistic regression.
Results: Totally, 2437 patients were included (57.2% male, 79.1% born outside the UK). Overall, 82.3% completed treatment and 4.1% died. Factors associated with mortality included older age (over 70 years odds ratio (OR) 3.3), inpatient diagnosis (OR 4.4), and mental health issues (OR 2.2). 52.8% received ECM, with the proportion increasing over time, and 76% of this group successfully competed treatment.
Conclusions: This comprehensive evaluation of ECM in a diverse London population indicates high treatment completion rates even among those with multiple social risk factors. However, ECM needs of patients has increased over time, with a particular rise in patients requiring the highest support level. Given the small difference between standard care and ECM categories 1 and 2, there may be scope to simplify the system.
期刊介绍:
JRSM Open is a peer reviewed online-only journal that follows the open-access publishing model. It is a companion journal to the Journal of the Royal Society of Medicine. The journal publishes research papers, research letters, clinical and methodological reviews, and case reports. Our aim is to inform practice and policy making in clinical medicine. The journal has an international and multispecialty readership that includes primary care and public health professionals.