Tuberculosis management practices in Kentucky: comparison with national guidelines.
BACKGROUND
We assessed the quality of tuberculosis management practices in a predominantly rural state.


METHODS
Medical records of persons reported to the Centers for Disease Control and Prevention (CDC) with the diagnosis of tuberculosis were audited; management practices were compared with guidelines from the American Thoracic Society (ATS) and CDC.


RESULTS
We reviewed 207 records from 24 health districts in Kentucky. These records represented 30% of the cases reported to the CDC during the 17-month study. Tuberculosis was diagnosed by culture in 66% of patients; 12 different antibiotic regimens for antibiotic sensitive bacteria were prescribed; human immunodeficiency virus testing was documented in only 39%; monitoring for drug toxicity and bacteriologic cure was appropriate in < 65%; directly observed therapy was used in only 38%, and only 23% of close contacts were reevaluated at 12 weeks.


CONCLUSIONS
Tuberculosis management practices in Kentucky fall short of ATS/CDC guidelines. Continuing quality-improvement efforts are warranted.
Evans
M E
ME
Department of Internal Medicine, University of Kentucky School of Medicine, Lexington 40536-0084, USA.
Perkins
D J
DJ
Simmons
G D
GD
D000368:Aged; D000904:Antibiotics, Antitubercular / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D006306:Health Surveys; D006801:Humans; D007629:Kentucky / Q000453:epidemiology; D008499:Medical Records; D017410:Practice Guidelines as Topic; D011216:Practice Management, Medical / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012424:Rural Population; D013183:Sputum / Q000382:microbiology; D014374:Tuberculin Test; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D014481:United States
D000904:Antibiotics, Antitubercular; D000995:Antitubercular Agents