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Collaboration with school nurses: improving the effectiveness of tuberculosis screening.
C W DeLago1, N D Spector, B Moughan
1Section of General Pediatrics, St Christopher's Hospital for Children and MCP Hahnemann University School of Medicine, Erie Avenue at Front Street, Philadelphia, PA 19134-1095, USA. Cynthia.W.DeLago@drexel.edu
Archives of Pediatrics & Adolescent Medicine
|December 26, 2001
Summary
Physician requests for school nurses to read tuberculosis skin tests (TSTs) significantly increased test reading rates in children. This collaboration improved TST completion, overcoming parental barriers and communication failures.
Area of Science:
- Pediatric Public Health
- Infectious Disease Management
- Healthcare Communication
Background:
- Tuberculosis skin testing (TST) is crucial for early detection in children.
- Low TST reading rates pose a challenge in pediatric care, often due to parental or communication barriers.
- Effective TST completion is vital for timely diagnosis and treatment of tuberculosis.
Purpose of the Study:
- To compare TST reading rates in children when school nurses read tests upon physician request versus parental responsibility.
- To evaluate the impact of direct physician-to-school nurse communication on TST completion.
- To identify barriers affecting TST reading and reporting in an urban pediatric practice.
Main Methods:
- A randomized controlled trial involving healthy, low-income Hispanic and African American children (5-17 years) attending public schools.
- Intervention group: Physicians requested school nurses to read TSTs; Control group: Parents were responsible for TST reading.
- School nurses received specific instructions for TST reading and reporting back to the physician's office.
Main Results:
- The intervention group showed significantly higher TST reading rates by 72 hours (92%) compared to the control group (56%; P<.001).
- Communication failures were identified as the primary reason for low TST reading rates in the control group.
- Enrollment included 134 children, with 80 in the intervention and 54 in the control group.
Conclusions:
- Systematic collaboration between physicians and school nurses effectively increases tuberculosis skin test reading rates.
- Engaging school nurses is a viable strategy to improve TST completion and adherence in pediatric populations.
- Targeted communication protocols can overcome common impediments to TST follow-up.