After years of declining levels of tuberculosis (TB), New York City experienced a dramatic resurgence in the 1980s and 1990s. Cases rose almost 200 percent from 1,307 in 1978 to 3,811 in 1992. By the mid-1990s, New York was reporting far more TB cases than any other city. TB control presents a complex challenge because of the multiple stages required for treatment. Part of the resurgence has been attributed to patients abandoning this process, which can last up to two years.
In order to control the spread of TB, the Bureau of Tuberculosis Control (BTBC) instituted a number of new methods in conjunction with a significant increase in staffing and resources. The Patient Review Approach, a systematic method for reviewing the effectiveness of the TB control program, also ensures staff accountability in proactively treating TB patients.
The review is scheduled four times a year to assess the treatment progress all TB patients in the New York area. Case managers are assigned to review a set number of patients. This case manager, assigned by the BTBC, is then responsible for monitoring adherence to treatment, including clinical and laboratory information. The case manager works closely with physicians, hospital discharge planners, and infection control practitioners in order to better facilitate patients' treatment.
Case managers then present their patients' progress to their immediate supervisors. On a quarterly basis, patient reviews identify problems with patient adherence, social issues that may interfere with adherence, the adequacy of the medication regimen and the adequacy of patient monitoring during treatment. This kind of review ensures accountability and quality case management while educating staff members about the practical aspects of TB treatment on an ongoing basis.
The Patient Review Approach treats patients more effectively and comfortably, while also increasing staff awareness and effectiveness in assisting with the treatment process. Since the inception of BTBC's new method, treatment completion levels have risen from less than 50 percent to over 93 percent. There has also been a notable increase in BTBC staff morale, as well as case managers' levels of commitment to individual patients. In the end, the Patient Review approach facilitates significant efficiency and effectiveness in the overall TB treatment program.