Tuberculosis Management Practices in Kentucky: Comparison With National Guidelines

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Abstract

Background.

We assessed the quality of tuberculosis management practices in a predominantly rural state.

Methods.

Medical records of persons reported to the Centers for Disease Control and Prevention (CDC) with the diagnosis of tuberculosis were audited; management practices were compared with guidelines from the American Thoracic Society (ATS) and CDC.

Results.

We reviewed 207 records from 24 health districts in Kentucky. These records represented 30% of the cases reported to the CDC during the 17-month study. Tuberculosis was diagnosed by culture in 66% of patients; 12 different antibiotic regimens for antibiotic sensitive bacteria were prescribed; human immunodeficiency virus testing was documented in only 39%; monitoring for drug toxicity and bacteriologic cure was appropriate in <65%; directly observed therapy was used in only 38%, and only 23% of close contacts were reevaluated at 12 weeks.

Conclusions.

Tuberculosis management practices in Kentucky fall short of ATS/CDC guidelines. Continuing quality-improvement efforts are warranted.

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