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Table 5 Audit of TB services against items from the national TB Action Plan

From: Tuberculosis in UK cities: workload and effectiveness of tuberculosis control programmes

Criterion Birmingham Bradford Glasgow Leeds Leicester London Manchester Sheffield
1. Have you had a formal peer review against the NICE guidelines? No No No - Scottish guidelines still awaiting agreement Internal review No - regular audits and epidemiological review Formal reviews are carried out in NE and NC London Annual audit against NICE guidelines Yes
2. Do you have GP training days with a focus on TB in your area? Yes Annual No No No training days solely for TB but regular presentations to GPs as part of other meetings GP training days are not widely held No Yes
3. What did you do for the last World TB Day Stands at supermarkets, mosques, community centres, four hospitals. Information leaflets about TB was sent to all Birmingham GP's Nothing Posters and information leaflets around health centres and hospital Nothing Public awareness campaign with representation in the community and specific event organised for primary care with information pack on a CD. Most TB services carried out public awareness programs Insufficient staff to do anything Article in GP communication magazine; TB nurses involved in nurse education, annual evidence reviews and in the past had a stall in main shopping mall.
4. Having identified high risk groups in your area, what sort of educational outreach have you been able to do in the last 2-3 years? Seminars in nursing and care homes, training of community nurses about TB, educational meeting in certain ethnic communities Language barriers have prevented outreach work High risk groups identified (alcohol problems), but no educational outreach Yes.
First in 2011
Some work with community development workers around World TB Day and teaching sessions to community groups. Targeted representation at health fairs TB Find and Treat has been actively involved in the homeless and intravenous drug users. Just starting outreach with help of charity, TB Alert. TB nurses have targeted practices with most TB cases; Somali community addressed by ex-patients and community leaders.
5. Does your local medical school give teaching on TB (do you do it)? Yes Teaching given in 3rd and 5th years Yes - I give 1 lecture a year TB is in the curriculum and all students that attend St James University Hospital receive TB teaching Yes. 2nd year lectures and tutorial on TB microbiology and clinical TB. I give a lecture annually. All five medical schools provide teaching on TB. Yes - I do it. Yes - I do it.
6. How often does your TB Network meet and what is its composition? 3-monthly: physicians, paediatricians, TB nurses microbiologists, public health, pharmacists and commissioners 3-monthly
Physicians, TB nurses, GP.
6 monthly. Public health (2 CIECs), paediatrician, ID physician, TB nurses, respiratory physicians from each hospital, microbiologist. a) weekly MDT with TB physician, ID physician, CCDC, TB nurses, microbiologist, PCR technician and pharmacist;
b) Leeds TB group quarterly with other hospital teams, primary care managers and co-opted as needed;
c) Twice yearly West Yorkshire TB teams
6 weekly meetings with respiratory physician, ID physician, HPA, TB nurses to discuss local epidemiology and difficult cases. A London TB group has been meeting regularly since 2000. Meetings were initially quarterly, but have increased considerably over the last two years 6-monthly Manchester group.
Includes 3 hospitals primary care, public health, TB doctors and nurses, microbiologist, infectious diseases (HIV) doctor.
Regional group meets 1-2× per year. TB forum meets with commissioners 2 × per year. Monthly MDT with infectious diseases, respiratory physicians, TB nurses, laboratory staff, public health and paedicatricians.
7. Do you have a local prison? How many ex- or current prisoners did you treat for TB last year? Yes
2
No
None
Yes.
Not recorded.
2 prisons - 1 case last year 2 prisons; 1 case per year. A TB specialist nurse attached to the prison health service was employed from 2006-2010 Yes.
1-2 patients per year.
Yes (Doncaster); 2 per year
8. Do you have a named key worker (accountable case manager) for each TB patient? Yes Yes Yes Yes Yes Yes Yes Yes
9. Are TB drugs free from your clinic? Yes Yes Yes (Scottish national policy) Yes Yes Yes Yes Yes
10. How many negative pressure rooms do you have in your hospital? 2 at Trust;
8 for Birmingham
6 at one site 2 4 13 in 2 trust hospitals Variations in supply exist across London, ranging from 0 to 12 in specialist hospitals None (available in a different hospital, under a different physician) 17
11. What percentage of TB cases came from screening programmes (contacts, immigrants, HIV+ and other) 52/264 (19.7)
52/509 (10.2)
25% Not available 18/125 (14.4%) 10% from contacts; 75% pulmonary cases identified by radiology based rapid access system Not recorded across the capital;
11/29 clinics perform new entrant screeninga
6.9 1-2% per year
12. Do you have a joint TB-HIV clinic? Yes Run by infectious diseases physician No Just starting Yes between ID and GUM physicians All sectors have at least one TB-HIV clinic; only 3 of 29 clinics reported difficulty accessing an HIV servicea No, but weekly joint MDT. Same physician
13. What percentage of your patients had DOT at some point in their treatment last year? 21 0 None 3 5 Access to DOT is variable across London (range 1.7-32% of all patients)a 2 5-10%
14. Target of 1 nurse per 40 notifications* 1:80-90 to 2008
1:60-70 from 2008
No specified TB nurses Not achieved Achieved Achieved from 2000 Set 2000
Mostly achieved by 2007; range 1;21 to 1;51 in 2009a
Not achieved
2 nurses from 2000
Achieved 2006
15. How many hours are assigned to TB in your job plan? 12 None - TB seen as part of general respiratory clinics 4 8 4 Varies from 0 to 16, but unrelated to TB numbers 2 4 for TB clinic and 12 in total.
  1. *The ratio of notifications per TB nurses was not specified in the national Action Plan, nor in the NICE guidelines.
  2. aData from PHAST report
  3. Abbreviations used: CCDC - consultant in communicable disease control (i.e. public health physician); CIEC - consultant in infection and envornmental control (i.e. public health physician); CD - compact disk; GP - general practitioner (family or primary care doctor); HPA - Health Protection Agency (i.e. public health); MDT - multidisciplinary team; NICE - National Institute for Health and Clinical Excellence; TB - tuberculosis.
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