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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
Insights
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.
Objective:
To compare tuberculosis skin test (TST) reading rates between children whose tests were read by school nurses following specific requests by physicians and those who relied on their parents to get their tests read, either at school or at the physician's office.
Design:
A randomized controlled trial.
Setting:
An urban hospital-based pediatric practice.
Participants:
Healthy low-income Hispanic and African American children aged 5 to 17 years whose physicians ordered TSTs at their routine physical examinations. Subjects attended 1 of 68 public schools. Nurses at these schools were willing to read student TSTs, and received instructions about how to read and report the results back to the physician's office.
Intervention:
Subjects were randomized to a control group (routine TST placement, with no physician-to-school nurse communication) or to an intervention group (routine TST placement, with physician-to-school nurse communication).
Main Outcome Measures:
Tuberculosis skin test reading rates between the 2 groups were compared. Impediments to TST reading and reporting were investigated.
Results:
One hundred thirty-four children were enrolled, 54 (40%) in the control group and 80 (60%) in the intervention group. More patients in the intervention group had their TSTs read by 72 hours compared with those in the control group (74 [92%] vs 30 [56%]; P<.001). The low reading rate in the control group was best attributed to communication failures.
Conclusion:
Systematic collaboration with school nurses can increase TST reading rates.