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Tuberculosis (TB) surveillance relies heavily on laboratories and providers to report cases to local health departments. TB surveillance data can be compromised by underreporting, particularly by private-sector clinicians who treat TB infrequently. In a recent study, researchers assessed the usefulness of pharmacy data on anti-TB medications—which are rarely used to treat other conditions—for helping public health officials find TB cases and assess their management by private-sector clinicians. The study was supported in part by AHRQ through a cooperative agreement (HS10391) with the HMO Research Network Center for Education and Research on Therapeutics (CERT).
The researchers evaluated the contribution of pharmacy data from three different health plans in Michigan, Missouri, and Tennessee to identification of TB cases. The pharmacy databases identified individuals with more than two anti-TB medications. The researchers confirmed active TB cases by using State TB registries, medical record review, or responses to questionnaires sent to prescribing physicians. Overall, they identified 207 active TB cases, including 13 (6 percent) that had been missed by traditional surveillance and thus had not been reported to State health departments. All except one involved people with active pulmonary disease.
Screening of medications dispensed by the pharmacies identified 80 percent of individuals with TB who had received their medications through health plan-reimbursed sources but missed those treated solely in public health clinics. Pharmacy data also provided useful information about physicians' management of TB and patients' adherence to prescribed therapy. For all 17 patients not treated in public health clinics, the final drug regimen described in the medical record was adequate with regard to medications used, doses prescribed, and intended duration of treatment.
More details are in "Pharmacy data for tuberculosis surveillance and assessment of patient management," by Deborah S. Yokoe, M.D., M.P.H., Steven W. Coon, M.P.H., Rachel Dokholyan, M.P.H., and others, in the August 2004 Emerging Infectious Diseases 10(8), pp. 1426-1431.
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