Tuberculosis screening in patients with HIV: use of audit and feedback to improve quality of care in Ghana
Identifieur interne : 000120 ( Main/Exploration ); précédent : 000119; suivant : 000121Tuberculosis screening in patients with HIV: use of audit and feedback to improve quality of care in Ghana
Auteurs : Stephanie Bjerrum [Danemark] ; Frank Bonsu [Ghana] ; Nii Nortey Hanson-Nortey [Ghana] ; Ernest Kenu [Ghana] ; Isik Somuncu Johansen [Danemark] ; Aase Bengaard Andersen [Danemark] ; Lars Bjerrum [Danemark] ; Dorte Jarb L [Danemark] ; Anders Munck [Danemark]Source :
- Global Health Action [ 1654-9716 ] ; 2016.
Abstract
Tuberculosis screening of people living with HIV (PLHIV) can contribute to early tuberculosis diagnosis and improved patient outcomes. Evidence-based guidelines for tuberculosis screening are available, but literature assessing their implementation and the quality of clinical practice is scarce.
To assess tuberculosis screening practices and the effectiveness of audit and performance feedback to improve quality of tuberculosis screening at HIV care clinics in Ghana.
Healthcare providers at 10 large HIV care clinics prospectively registered patient consultations during May and October 2014, before and after a performance feedback intervention in August 2014. The outcomes of interest were overall tuberculosis suspicion rate during consultations and provider adherence to the International Standards for Tuberculosis Care and the World Health Organizations’ guidelines for symptom-based tuberculosis screening among PLHIV.
Twenty-one healthcare providers registered a total of 2,666 consultations; 1,368 consultations before and 1,298 consultations after the feedback intervention. Tuberculosis suspicion rate during consultation increased from 12.6 to 20.9% after feedback (odds ratio, OR 1.83; 95% confidence interval, CI: 1.09–3.09). Before feedback, sputum smear microscopy was requested for 58.7% of patients with suspected tuberculosis, for 47.2% of patients with cough ≥2 weeks, and for 27.5% of patients with a positive World Health Organization (WHO) symptom screen (any of current cough, fever, weight loss or night sweats). After feedback, patients with a positive WHO symptom screen were more likely to be suspected of tuberculosis (OR 2.21; 95% CI: 1.19–4.09) and referred for microscopy (OR 2.71; 95% CI: 1.25–5.86).
A simple prospective audit tool identified flaws in clinical practices for tuberculosis screening of PLHIV. There was no systematic identification of people with suspected active tuberculosis. We found low initial tuberculosis suspicion rate compounded by low referral rates of relevant patients for sputum smear microscopy. Adherence to recommended standards and guidelines for tuberculosis screening improved after performance feedback.
Url:
DOI: 10.3402/gha.v9.32390
PubMed: 27569593
PubMed Central: 5002398
Affiliations:
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Faculty of Health Sciences, University of Southern Denmark, Odense</wicri:regionArea><wicri:noRegion>Odense</wicri:noRegion></affiliation></author><author><name sortKey="Bonsu, Frank" sort="Bonsu, Frank" uniqKey="Bonsu F" first="Frank" last="Bonsu">Frank Bonsu</name><affiliation wicri:level="3"><nlm:aff id="AF0003">National Tuberculosis Control Programme, Disease Control and Prevention Department, Ghana Health Services, Korle-Bu Teaching Hospital, Accra, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>National Tuberculosis Control Programme, Disease Control and Prevention Department, Ghana Health Services, Korle-Bu Teaching Hospital, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName></affiliation></author><author><name sortKey="Hanson Nortey, Nii Nortey" sort="Hanson Nortey, Nii Nortey" uniqKey="Hanson Nortey N" first="Nii Nortey" last="Hanson-Nortey">Nii Nortey Hanson-Nortey</name><affiliation wicri:level="3"><nlm:aff id="AF0003">National Tuberculosis Control Programme, Disease Control and Prevention Department, Ghana Health Services, Korle-Bu Teaching Hospital, Accra, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>National Tuberculosis Control Programme, Disease Control and Prevention Department, Ghana Health Services, Korle-Bu Teaching Hospital, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName></affiliation></author><author><name sortKey="Kenu, Ernest" sort="Kenu, Ernest" uniqKey="Kenu E" first="Ernest" last="Kenu">Ernest Kenu</name><affiliation wicri:level="3"><nlm:aff id="AF0004">Department of Medicine–Fevers Unit, Korle-Bu Teaching Hospital, Accra, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Department of Medicine–Fevers Unit, Korle-Bu Teaching Hospital, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName></affiliation><affiliation wicri:level="4"><nlm:aff id="AF0005">School of Public Health, University of Ghana, Legon, Accra, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>School of Public Health, University of Ghana, Legon, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName><orgName type="university">Université du Ghana</orgName></affiliation></author><author><name sortKey="Johansen, Isik Somuncu" sort="Johansen, Isik Somuncu" uniqKey="Johansen I" first="Isik Somuncu" last="Johansen">Isik Somuncu Johansen</name><affiliation wicri:level="1"><nlm:aff id="AF0001">Department of Infectious Diseases, Odense University Hospital, Odense, Denmark</nlm:aff><country xml:lang="fr">Danemark</country><wicri:regionArea>Department of Infectious Diseases, Odense University Hospital, Odense</wicri:regionArea><wicri:noRegion>Odense</wicri:noRegion></affiliation></author><author><name sortKey="Andersen, Aase Bengaard" sort="Andersen, Aase Bengaard" uniqKey="Andersen A" first="Aase Bengaard" last="Andersen">Aase Bengaard Andersen</name><affiliation wicri:level="1"><nlm:aff id="AF0002">Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark</nlm:aff><country xml:lang="fr">Danemark</country><wicri:regionArea>Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense</wicri:regionArea><wicri:noRegion>Odense</wicri:noRegion></affiliation><affiliation wicri:level="3"><nlm:aff id="AF0006">Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark</nlm:aff><country xml:lang="fr">Danemark</country><wicri:regionArea>Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen</wicri:regionArea><placeName><settlement type="city">Copenhague</settlement><region type="région" nuts="2">Hovedstaden</region></placeName></affiliation></author><author><name sortKey="Bjerrum, Lars" sort="Bjerrum, Lars" uniqKey="Bjerrum L" first="Lars" last="Bjerrum">Lars Bjerrum</name><affiliation wicri:level="3"><nlm:aff id="AF0007">Department of Public Health, University of Copenhagen, Copenhagen, Denmark</nlm:aff><country xml:lang="fr">Danemark</country><wicri:regionArea>Department of Public Health, University of Copenhagen, Copenhagen</wicri:regionArea><placeName><settlement type="city">Copenhague</settlement><region type="région" nuts="2">Hovedstaden</region></placeName></affiliation></author><author><name sortKey="Jarb L, Dorte" sort="Jarb L, Dorte" uniqKey="Jarb L D" first="Dorte" last="Jarb L">Dorte Jarb L</name><affiliation wicri:level="1"><nlm:aff id="AF0008">Department of Public Health, University of Southern Denmark, Odense, Denmark</nlm:aff><country xml:lang="fr">Danemark</country><wicri:regionArea>Department of Public Health, University of Southern Denmark, Odense</wicri:regionArea><wicri:noRegion>Odense</wicri:noRegion></affiliation></author><author><name sortKey="Munck, Anders" sort="Munck, Anders" uniqKey="Munck A" first="Anders" last="Munck">Anders Munck</name><affiliation wicri:level="1"><nlm:aff id="AF0008">Department of Public Health, University of Southern Denmark, Odense, Denmark</nlm:aff><country xml:lang="fr">Danemark</country><wicri:regionArea>Department of Public Health, University of Southern Denmark, Odense</wicri:regionArea><wicri:noRegion>Odense</wicri:noRegion></affiliation></author></analytic><series><title level="j">Global Health Action</title><idno type="ISSN">1654-9716</idno><idno type="eISSN">1654-9880</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="st1"><title>Background</title><p>Tuberculosis screening of people living with HIV (PLHIV) can contribute to early tuberculosis diagnosis and improved patient outcomes. Evidence-based guidelines for tuberculosis screening are available, but literature assessing their implementation and the quality of clinical practice is scarce.</p></sec><sec id="st2"><title>Objectives</title><p>To assess tuberculosis screening practices and the effectiveness of audit and performance feedback to improve quality of tuberculosis screening at HIV care clinics in Ghana.</p></sec><sec id="st3"><title>Design</title><p>Healthcare providers at 10 large HIV care clinics prospectively registered patient consultations during May and October 2014, before and after a performance feedback intervention in August 2014. The outcomes of interest were overall tuberculosis suspicion rate during consultations and provider adherence to the International Standards for Tuberculosis Care and the World Health Organizations’ guidelines for symptom-based tuberculosis screening among PLHIV.</p></sec><sec id="st4"><title>Results</title><p>Twenty-one healthcare providers registered a total of 2,666 consultations; 1,368 consultations before and 1,298 consultations after the feedback intervention. Tuberculosis suspicion rate during consultation increased from 12.6 to 20.9% after feedback (odds ratio, OR 1.83; 95% confidence interval, CI: 1.09–3.09). Before feedback, sputum smear microscopy was requested for 58.7% of patients with suspected tuberculosis, for 47.2% of patients with cough ≥2 weeks, and for 27.5% of patients with a positive World Health Organization (WHO) symptom screen (any of current cough, fever, weight loss or night sweats). After feedback, patients with a positive WHO symptom screen were more likely to be suspected of tuberculosis (OR 2.21; 95% CI: 1.19–4.09) and referred for microscopy (OR 2.71; 95% CI: 1.25–5.86).</p></sec><sec id="st5"><title>Conclusions</title><p>A simple prospective audit tool identified flaws in clinical practices for tuberculosis screening of PLHIV. There was no systematic identification of people with suspected active tuberculosis. We found low initial tuberculosis suspicion rate compounded by low referral rates of relevant patients for sputum smear microscopy. Adherence to recommended standards and guidelines for tuberculosis screening improved after performance feedback.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Gupta, A" uniqKey="Gupta A">A Gupta</name></author><author><name sortKey="Nadkarni, G" uniqKey="Nadkarni G">G Nadkarni</name></author><author><name sortKey="Yang, Wt" uniqKey="Yang W">WT Yang</name></author><author><name sortKey="Chandrasekhar, A" uniqKey="Chandrasekhar A">A Chandrasekhar</name></author><author><name sortKey="Gupte, N" uniqKey="Gupte N">N Gupte</name></author><author><name sortKey="Bisson, Gp" uniqKey="Bisson G">GP Bisson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gupta, Rk" uniqKey="Gupta R">RK Gupta</name></author><author><name sortKey="Lucas, Sb" uniqKey="Lucas S">SB Lucas</name></author><author><name sortKey="Fielding, Kl" uniqKey="Fielding K">KL Fielding</name></author><author><name sortKey="Lawn, Sd" 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S">S Kudsk-Iversen</name></author><author><name sortKey="Vandelanotte, J" uniqKey="Vandelanotte J">J Vandelanotte</name></author><author><name sortKey="Nkawanyana, S" uniqKey="Nkawanyana S">S Nkawanyana</name></author><author><name sortKey="Welfare, W" uniqKey="Welfare W">W Welfare</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kanara, N" uniqKey="Kanara N">N Kanara</name></author><author><name sortKey="Cain, Kp" uniqKey="Cain K">KP Cain</name></author><author><name sortKey="Laserson, Kf" uniqKey="Laserson K">KF Laserson</name></author><author><name sortKey="Vannarith, C" uniqKey="Vannarith C">C Vannarith</name></author><author><name sortKey="Sameourn, K" uniqKey="Sameourn K">K Sameourn</name></author><author><name sortKey="Samnang, K" uniqKey="Samnang K">K Samnang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Botha, E" uniqKey="Botha E">E Botha</name></author><author><name sortKey="Den Boon, S" uniqKey="Den Boon S">S den Boon</name></author><author><name sortKey="Lawrence, Ka" uniqKey="Lawrence K">KA Lawrence</name></author><author><name sortKey="Reuter, H" uniqKey="Reuter H">H Reuter</name></author><author><name sortKey="Verver, S" uniqKey="Verver S">S Verver</name></author><author><name sortKey="Lombard, Cj" uniqKey="Lombard C">CJ Lombard</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bjerrum, S" uniqKey="Bjerrum S">S Bjerrum</name></author><author><name sortKey="Kenu, E" uniqKey="Kenu E">E Kenu</name></author><author><name sortKey="Lartey, M" uniqKey="Lartey M">M Lartey</name></author><author><name sortKey="Newman, Mj" uniqKey="Newman M">MJ Newman</name></author><author><name sortKey="Addo, Kk" uniqKey="Addo K">KK Addo</name></author><author><name sortKey="Andersen, Ab" uniqKey="Andersen A">AB Andersen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Balcha, Tt" uniqKey="Balcha T">TT Balcha</name></author><author><name sortKey="Skogmar, S" uniqKey="Skogmar S">S Skogmar</name></author><author><name sortKey="Sturegard, E" uniqKey="Sturegard E">E Sturegard</name></author><author><name sortKey="Schon, T" uniqKey="Schon T">T Schon</name></author><author><name sortKey="Winqvist, N" uniqKey="Winqvist N">N Winqvist</name></author><author><name sortKey="Reepalu, A" uniqKey="Reepalu A">A Reepalu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Churchyard, Gj" uniqKey="Churchyard G">GJ Churchyard</name></author><author><name sortKey="Stevens, Ws" uniqKey="Stevens W">WS Stevens</name></author><author><name sortKey="Mametja, Ld" uniqKey="Mametja L">LD Mametja</name></author><author><name sortKey="Mccarthy, Km" uniqKey="Mccarthy K">KM McCarthy</name></author><author><name sortKey="Chihota, V" uniqKey="Chihota V">V Chihota</name></author><author><name sortKey="Nicol, Mp" uniqKey="Nicol M">MP Nicol</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Theron, G" uniqKey="Theron G">G Theron</name></author><author><name sortKey="Zijenah, L" uniqKey="Zijenah L">L Zijenah</name></author><author><name sortKey="Chanda, D" uniqKey="Chanda D">D Chanda</name></author><author><name sortKey="Clowes, P" uniqKey="Clowes P">P Clowes</name></author><author><name sortKey="Rachow, A" uniqKey="Rachow A">A Rachow</name></author><author><name sortKey="Lesosky, M" uniqKey="Lesosky M">M Lesosky</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rudolf, F" uniqKey="Rudolf F">F Rudolf</name></author><author><name sortKey="Wejse, C" uniqKey="Wejse C">C Wejse</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Danemark</li><li>Ghana</li></country><region><li>Hovedstaden</li><li>Région du Grand Accra</li></region><settlement><li>Accra</li><li>Copenhague</li></settlement><orgName><li>Université du Ghana</li></orgName></list><tree><country name="Danemark"><noRegion><name sortKey="Bjerrum, Stephanie" sort="Bjerrum, Stephanie" uniqKey="Bjerrum S" first="Stephanie" last="Bjerrum">Stephanie Bjerrum</name></noRegion><name sortKey="Andersen, Aase Bengaard" sort="Andersen, Aase Bengaard" uniqKey="Andersen A" first="Aase Bengaard" last="Andersen">Aase Bengaard Andersen</name><name sortKey="Andersen, Aase Bengaard" sort="Andersen, Aase Bengaard" uniqKey="Andersen A" first="Aase Bengaard" last="Andersen">Aase Bengaard Andersen</name><name sortKey="Bjerrum, Lars" sort="Bjerrum, Lars" uniqKey="Bjerrum L" first="Lars" last="Bjerrum">Lars Bjerrum</name><name sortKey="Bjerrum, Stephanie" sort="Bjerrum, Stephanie" uniqKey="Bjerrum S" first="Stephanie" last="Bjerrum">Stephanie Bjerrum</name><name sortKey="Jarb L, Dorte" sort="Jarb L, Dorte" uniqKey="Jarb L D" first="Dorte" last="Jarb L">Dorte Jarb L</name><name sortKey="Johansen, Isik Somuncu" sort="Johansen, Isik Somuncu" uniqKey="Johansen I" first="Isik Somuncu" last="Johansen">Isik Somuncu Johansen</name><name sortKey="Munck, Anders" sort="Munck, Anders" uniqKey="Munck A" first="Anders" last="Munck">Anders Munck</name></country><country name="Ghana"><region name="Région du Grand Accra"><name sortKey="Bonsu, Frank" sort="Bonsu, Frank" uniqKey="Bonsu F" first="Frank" last="Bonsu">Frank Bonsu</name></region><name sortKey="Hanson Nortey, Nii Nortey" sort="Hanson Nortey, Nii Nortey" uniqKey="Hanson Nortey N" first="Nii Nortey" last="Hanson-Nortey">Nii Nortey Hanson-Nortey</name><name sortKey="Kenu, Ernest" sort="Kenu, Ernest" uniqKey="Kenu E" first="Ernest" last="Kenu">Ernest Kenu</name><name sortKey="Kenu, Ernest" sort="Kenu, Ernest" uniqKey="Kenu E" first="Ernest" last="Kenu">Ernest Kenu</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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