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Tuberculosis testing. Physician attitudes and practice
T L Cheng1, E B Miller, M Ottolini
1Department of General Pediatrics, Children's National Medical Center, George Washington University, Washington, DC, USA.
Archives of Pediatrics & Adolescent Medicine
|July 1, 1996
Summary
Most physicians do not follow American Academy of Pediatrics (AAP) tuberculosis screening guidelines for children. Practices vary widely in testing frequency, methods, and risk assessment, impacting adherence to AAP recommendations.
Area of Science:
- Pediatrics
- Infectious Disease Control
- Public Health
Background:
- The American Academy of Pediatrics (AAP) established guidelines for tuberculosis (TB) screening in children.
- Assessing physician adherence to these guidelines is crucial for effective TB control in pediatric populations.
Purpose of the Study:
- To evaluate the agreement and adoption rates of the 1994 AAP recommendations on pediatric tuberculosis screening among community physicians.
- To identify factors influencing physician adherence to TB screening guidelines.
Main Methods:
- A survey was conducted among 1272 community pediatricians and family physicians in four mid-Atlantic states and the District of Columbia.
- The survey assessed awareness, current practices, and perceived barriers related to AAP TB screening recommendations.
Main Results:
- Awareness of the 1994 AAP guidelines was high (75%), but only 22% of physicians adhered to all recommendations (frequency, method, reading).
- Physician practices varied significantly, with most physicians tailoring testing frequency and methods based on patient risk.
- The use of multiple-puncture tests declined, but remained prevalent; accurate reading of test reactions was a significant concern.
Conclusions:
- Physician practices for tuberculosis testing in children demonstrate considerable variability and generally do not align with the 1994 AAP recommendations.
- Physician and practice characteristics, along with knowledge of guidelines, were associated with adherence.
- Addressing concerns about test interpretation and standardizing practices are essential for improving pediatric TB screening outcomes.