Griffiths Chris, Sturdy Pat, Brewin Penny, Bothamley Graham, Eldridge Sandra, Martineau Adrian, MacDonald Meg, Ramsay Jean, Tibrewal Suresh, Levi Sue, Zumla Ali, Feder Gene
Centre for Health Sciences, Barts and The London, Queen Mary's School of Medicine and Dentistry, London, UK; Lower Clapton Group Practice, Lower Clapton Road, Hackney, UK; MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London School of Medicine, Guy's Hospital, St. Thomas' Street, London SE1 9RT, UK.
Centre for Health Sciences, Barts and The London, Queen Mary's School of Medicine and Dentistry, London, UK; Lower Clapton Group Practice, Lower Clapton Road, Hackney, UK.
Lancet. 2007 May 5;369(9572):1528-1534. doi: 10.1016/S0140-6736(07)60707-7.
Tuberculosis is re-emerging as an important health problem in industrialised countries. Uncertainty surrounds the effect of public-health control options. We therefore aimed to assess a programme to promote screening for tuberculosis in a UK primary health care district.
In a cluster randomised controlled trial, we randomised 50 of 52 (96%) eligible general practices in Hackney, London, UK, to receive an outreach programme that promoted screening for tuberculosis in people registering in primary care, or to continue with usual care. Screening was verbal, and proceeded to tuberculin skin testing, if appropriate. The primary outcome was the proportion of new cases of active tuberculosis identified in primary care. Analyses were done on an intention-to-treat basis. This study was registered at clinicaltrials.gov, number NCT00214708.
Between June 1, 2002, and Oct 1, 2004, 44,986 and 48,984 patients registered with intervention and control practices, respectively. In intervention practices 57% (13,478 of 23,573) of people attending a registration health check were screened for tuberculosis compared with 0.4% (84 of 23 051) in control practices. Intervention practices showed increases in the diagnosis of active tuberculosis cases in primary care compared with control practices (66/141 [47%] vs 54/157 [34%], odds ratio (OR) 1.68, 95% CI 1.05-2.68, p=0.03). Intervention practices also had increases in diagnosis of latent tuberculosis (11/59 [19%] vs 5/68 [9%], OR 3.00, 0.98-9.20, p=0.055) and BCG coverage (mean BCG rate 26.8/1000 vs 3.8/1000, intervention rate ratio 9.52, 4.0-22.7, p<0.001).
Our educational intervention for promotion of screening for tuberculosis in primary care improved identification of active and latent tuberculosis, and increased BCG coverage. Yield from screening was low, but was augmented by improved case-finding. Screening programmes in primary care should be considered as part of tuberculosis control initiatives in industrialised countries.
在工业化国家，结核病再度成为一个重要的健康问题。公共卫生控制措施的效果尚不确定。因此，我们旨在评估一项在英国初级卫生保健区促进结核病筛查的项目。
在一项整群随机对照试验中，我们将英国伦敦哈克尼区52家符合条件的全科诊所中的50家（96%）随机分组，一组接受一项推广项目，该项目促进对在初级保健机构登记的人员进行结核病筛查，另一组继续常规护理。筛查通过口头询问进行，必要时进行结核菌素皮肤试验。主要结局是在初级保健机构中确诊的活动性结核病新病例的比例。分析采用意向性分析。本研究已在clinicaltrials.gov注册，注册号为NCT00214708。
在2002年6月1日至2004年10月1日期间，分别有44986名和48984名患者在干预组和对照组诊所登记。在干预组诊所，57%（23573人中的13478人）在进行登记健康检查时接受了结核病筛查，而对照组诊所这一比例为0.4%（23051人中的84人）。与对照组诊所相比，干预组诊所在初级保健机构中确诊的活动性结核病例有所增加（66/141 [47%] 对54/157 [34%]，比值比（OR）1.68，95%置信区间1.05 - 2.68，p = 0.03）。干预组诊所潜伏性结核的诊断也有所增加（11/59 [19%] 对5/68 [9%]，OR 3.00，0.98 - 9.20，p = 0.055），卡介苗接种覆盖率也有所提高（卡介苗接种率均值为26.8/1000对3.8/1000，干预组与对照组接种率比值为9.52，4.0 - 22.7，p < 0.001）。
我们在初级保健机构促进结核病筛查的教育干预措施改善了活动性和潜伏性结核病的识别，并提高了卡介苗接种覆盖率。筛查的阳性率较低，但通过改进病例发现而有所提高。在工业化国家，初级保健机构的筛查项目应被视为结核病控制举措的一部分。
