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Extensión educativa para promover el cribado de la tuberculosis en la atención primaria: un ensayo controlado

Chris Griffiths¹, Pat Sturdy², Penny Brewin³

¹Centre 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.

Lancet (London, England)

|May 8, 2007

Resumen

Un programa de extensión de atención primaria en el Reino Unido mejoró significativamente la detección de la tuberculosis, lo que condujo a una mejor identificación de los casos activos y latentes de tuberculosis y a una mayor cobertura de vacunación BCG. Esto pone de relieve el valor de tales iniciativas en las naciones industrializadas.

Área de la Ciencia:

Salud Pública La salud pública.
Control y Control de Enfermedades Infecciosas
Medicina de la Atención Primaria La medicina de la atención primaria es la medicina de la atención primaria.

Sus antecedentes:

La tuberculosis (TB) es un problema de salud pública cada vez mayor en los países industrializados.
La efectividad de las actuales estrategias de control de la salud pública para la TB sigue siendo incierta.
Necesidad de evaluar nuevos enfoques para el cribado de TB en entornos de atención primaria.

Objetivo del estudio:

Evaluar un programa diseñado para mejorar la detección de la tuberculosis dentro de un distrito de atención primaria del Reino Unido.
Determinar el impacto de un programa de divulgación en la identificación de casos activos y latentes de TB.
Evaluar los cambios en la cobertura de vacunación contra el BCG como resultado de la intervención.

Principales métodos:

Un ensayo controlado aleatorizado de clúster que involucró a 50 prácticas generales en Hackney, Londres.
El grupo de intervención recibió un programa de divulgación que promueve el cribado de la tuberculosis; el grupo de control recibió la atención habitual.
El cribado incluyó evaluación verbal y pruebas cutáneas de tuberculina; el resultado primario fueron los casos activos de TB identificados en la atención primaria.

Principales resultados:

Tasas de detección de TB significativamente más altas en las prácticas de intervención (57%) en comparación con las prácticas de control (0,4%).
Aumento del diagnóstico de casos activos de TB en las prácticas de intervención (47% frente a 34%, OR 1,68, p=0,03).
Tendencias hacia un mayor diagnóstico de TB latente (19% frente a 9%, p=0,055) y una cobertura de BCG sustancialmente mayor (ratio de tasa 9,52, p<0,001).

Conclusiones:

La intervención educativa mejoró efectivamente la identificación de la tuberculosis activa y latente.
El programa condujo a un aumento significativo en las tasas de vacunación BCG.
Los programas de cribado de atención primaria deben considerarse parte integral de las estrategias de control de la tuberculosis en los países desarrollados.

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