ABSTRACT
AIM: This paper is a report of a study to examine the impact of social factors on the management of tuberculosis including engagement with services, hospitalization and extended treatment. BACKGROUND: Rates of tuberculosis in major European cities have increased greatly in the last 10 years. The changing epidemiology of the disease, concentrated in marginalized groups, presents new challenges to the control of tuberculosis. METHODS: A prospective cohort study of 250 newly diagnosed tuberculosis patients was conducted in London between January 2003 and January 2005. Data were collected by means of a risk assessment tool and from medical records. Outcome measures included missed appointments, frequency and duration of hospitalization and length of treatment. RESULTS: The median age of the study sample was 33.82 (range 16.4-92.5) and 56.8% were male. Thirty-two per cent were hostel/street homeless or temporarily sharing accommodation with friends or relatives. Thirty-nine per cent were in receipt of welfare benefits and 13.2% had no income. Over a third anticipated difficulties taking their medicines and 30.3% had noone to remind them of this. Increased hospitalization was associated with hostel/street homelessness, drug or alcohol use and having noone to remind them to take their medicines (all P Subject(s)
Social Environment
, Tuberculosis/therapy
, Adolescent
, Adult
, Aged
, Aged, 80 and over
, Cohort Studies
, Female
, Ill-Housed Persons
, Humans
, Incidence
, London/epidemiology
, Male
, Middle Aged
, Prospective Studies
, Risk Factors
, Substance-Related Disorders/complications
, Substance-Related Disorders/epidemiology
, Tuberculosis/complications
, Tuberculosis/epidemiology
ABSTRACT
AIM: The objective of this study was to investigate issues regarding adherence with tuberculosis therapy and the use of directly observed therapy. METHOD: A small-scale survey of TB nurse specialists at chest clinics in London was carried out to determine the current use of directly observed therapy for patients with tuberculosis in London. RESULTS: Responses to this survey indicate that directly observed therapy is currently used in less than half the available services in London. Many of the specialist TB nurses indicated that lack of resources and time were drawbacks to implementing directly observed therapy. CONCLUSION: Directly observed therapy was found to be a strategy that was infrequently used as a last measure for those people who were previous non-adherers.
Subject(s)
Attitude of Health Personnel , Directly Observed Therapy/nursing , Directly Observed Therapy/statistics & numerical data , Nurse Clinicians/psychology , Tuberculosis/drug therapy , Ambulatory Care/standards , Ambulatory Care/statistics & numerical data , Directly Observed Therapy/standards , Guideline Adherence/standards , Humans , London/epidemiology , Nurse Clinicians/organization & administration , Nurse's Role , Practice Guidelines as Topic , State Medicine/standards , State Medicine/statistics & numerical data , Surveys and Questionnaires , Time Factors , Treatment Refusal/psychology , Treatment Refusal/statistics & numerical data , Tuberculosis/epidemiology , Tuberculosis/nursing , Tuberculosis/psychology , WorkloadABSTRACT
Homeless families are vulnerable to considerable health problems, yet are overlooked in the government's national strategy for health. Access to services and contact with agencies are difficult for people displaced to a new area. Helen Lee and Ann Goodburn describe the health visiting service they offer homeless families in Camden, north London, where the majority are from outside the borough and many recent immigrants to this country.
