Long-term hospitalization for tuberculosis control. Experience with a medical-psychosocial inpatient unit.
BACKGROUND
Patients with tuberculosis (TB) who are nonadherent to therapy or have complicated medical or social problems pose a threat to public health. In some cases, hospitalization may be a necessary component of a comprehensive TB control program.


OBJECTIVE
To describe experience with a new inpatient program for TB control.


METHODS
Retrospective review.


METHODS
Eighteen-bed, secure, TB treatment unit in a state public health hospital providing a spectrum of acute and chronic care services.


METHODS
Patients with known or suspected TB who were unable to be treated as outpatients and were hospitalized from 1990 through 1995.


METHODS
Voluntary or involuntary hospitalization, with medical, psychosocial, and legal services.


METHODS
Admissions, treatment completion, and disposition.


RESULTS
A total of 166 patients with a confirmed diagnosis of TB accounted for 214 hospitalizations for TB. The mean age was 42 years, 132 (79.5%) were men, 84 (50.6%) were nonwhite, and 45 (27.1%) were foreign born. At the time of admission, 58 patients (34.5%) were homeless, 116 (69.9%) had a history of abuse of alcohol or other drugs, and 46 (31.7%) were positive for human immunodeficiency virus. The mean length of stay was 119.7 days (median, 70 days; range, 7-656 days), and was higher among homeless patients than nonhomeless patients (168.8 vs 93.4 days). Of 48 patients (28.9%) who were admitted involuntarily, 21 required long-term confinement under court order. Admission indications (not mutually exclusive) changed over 5 years: nonadherence decreased (95% to 34%), medical complexity increased (14% to 77%), short-term isolation increased (19% to 39%), and involuntary admission decreased (54% to 13%). Of 157 patients with positive cultures for Mycobacterium tuberculosis, 36 (23.1%) were resistant to at least 1 drug, including 16 who were multidrug resistant. A total of 123 patients (74.7%) were discharged to an outpatient setting to complete therapy, 40 (24.1%) required inpatient care to complete therapy, and 3 died (1 from TB) before discharge.


CONCLUSIONS
A high proportion of patients with TB who failed outpatient therapy completed treatment in a combined medical and psychosocial inpatient unit. During the 5-year study period, involuntary admissions decreased and most patients completed therapy as outpatients. In Massachusetts, this program plays an important role in protecting public health and in providing specialized medical management for patients to complete therapy in a safe and supportive environment.
Singleton
L
L
Division of Tuberculosis Prevention and Control, Massachusetts Department of Public Health, Boston 02130, USA. Linda.Singleton@state.ma.us
Turner
M
M
Haskal
R
R
Etkind
S
S
Tricarico
M
M
Nardell
E
E
D000328:Adult; D000995:Antitubercular Agents; D019090:Case Management; D003140:Communicable Disease Control / Q000379:methods*; D004352:Drug Resistance, Microbial; D018432:Drug Resistance, Multiple; D005260:Female; D006757:Hospital Units / Q000458:organization & administration* / Q000592:standards; D006783:Hospitals, State / Q000458:organization & administration / Q000592:standards; D006801:Humans; D007902:Length of Stay; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D009017:Morbidity; D010349:Patient Compliance; D010356:Patient Isolation; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014376:Tuberculosis / Q000453:epidemiology* / Q000628:therapy*
D000995:Antitubercular Agents