Diagnostic pathways and delay among tuberculosis patients in Stockholm, Sweden: a retrospective observational study.
Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Delayed Diagnosis
/ statistics & numerical data
Female
Humans
Infant
Infant, Newborn
Male
Mass Screening
/ statistics & numerical data
Medical Records
Middle Aged
Refugees
/ statistics & numerical data
Retrospective Studies
Sweden
/ epidemiology
Tuberculosis
/ diagnosis
Young Adult
Asylum seekers
Diagnostic delay
Health examination
Screening
Tuberculosis
Journal
BMC public health
ISSN: 1471-2458
Titre abrégé: BMC Public Health
Pays: England
ID NLM: 100968562
Informations de publication
Date de publication:
04 Feb 2019
04 Feb 2019
Historique:
received:
30
05
2018
accepted:
21
01
2019
entrez:
6
2
2019
pubmed:
6
2
2019
medline:
1
5
2019
Statut:
epublish
Résumé
Asylum seekers in Sweden are offered tuberculosis (TB) screening at a voluntary post-arrival health examination. The role of this screening in improving the TB diagnostic pathway has not been previously evaluated. The aim of this study was to determine diagnostic pathways for active TB cases and compare diagnostic delays between different pathways. Retrospective review of medical records of patients reported with active TB in Stockholm in 2015, using a structured and pre-coded form. Seventy-one percent of patients actively sought health care due to symptoms. As for source of referral to TB specialist clinic, 15% came from screening of eligible migrants, of whom the majority were asymptomatic. Among asylum seekers, 69% were identified through screening at a health examination (HE). The main sources of referral to TB clinics were emergency departments (27%) and primary health care centers (20%). Median health care provider delay was significantly longer in patients identified through migrant screening in health examination. Screening at a health examination was the main pathway of active TB detection among mainly asymptomatic and non-contagious asylum seekers but contributed modestly to total overall TB case detection. In these patients TB was diagnosed early in a non-contagious phase of the disease. Further research is required to assess the effectiveness and cost-effectiveness of HE TB screening as well as inclusion of other groups of migrants from high incidence countries in the screening program in terms of impact on delay, transmission and treatment outcomes.
Sections du résumé
BACKGROUND
BACKGROUND
Asylum seekers in Sweden are offered tuberculosis (TB) screening at a voluntary post-arrival health examination. The role of this screening in improving the TB diagnostic pathway has not been previously evaluated. The aim of this study was to determine diagnostic pathways for active TB cases and compare diagnostic delays between different pathways.
METHODS
METHODS
Retrospective review of medical records of patients reported with active TB in Stockholm in 2015, using a structured and pre-coded form.
RESULTS
RESULTS
Seventy-one percent of patients actively sought health care due to symptoms. As for source of referral to TB specialist clinic, 15% came from screening of eligible migrants, of whom the majority were asymptomatic. Among asylum seekers, 69% were identified through screening at a health examination (HE). The main sources of referral to TB clinics were emergency departments (27%) and primary health care centers (20%). Median health care provider delay was significantly longer in patients identified through migrant screening in health examination.
CONCLUSIONS
CONCLUSIONS
Screening at a health examination was the main pathway of active TB detection among mainly asymptomatic and non-contagious asylum seekers but contributed modestly to total overall TB case detection. In these patients TB was diagnosed early in a non-contagious phase of the disease. Further research is required to assess the effectiveness and cost-effectiveness of HE TB screening as well as inclusion of other groups of migrants from high incidence countries in the screening program in terms of impact on delay, transmission and treatment outcomes.
Identifiants
pubmed: 30717738
doi: 10.1186/s12889-019-6462-5
pii: 10.1186/s12889-019-6462-5
pmc: PMC6360687
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
151Subventions
Organisme : Forskningsrådet om Hälsa, Arbetsliv och Välfärd
ID : 2015-00304
Organisme : Hjärt-Lungfonden
ID : 20160508
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