Evaluating provider prescribing practices for the treatment of tuberculosis in Virginia, 1995 to 1998: an assessment of educational need.
BACKGROUND
Although the use of epidemiologic studies to demonstrate learning needs appears to be infrequent, this study addressed the discrepancies in the prescribing practices for the initial treatment of tuberculosis in Virginia between public and private clinicians, comparing them with the treatment regimens recommended by the Centers for Disease Control and Prevention and the American Thoracic Society (CDC-ATS).


METHODS
Data examined were the 1995 to 1998 reported cases of tuberculosis within the Commonwealth of Virginia. The study population consisted of 770 laboratory-confirmed tuberculosis cases, living in Virginia, whose isolates were tested for isoniazid susceptibility and were prescribed an initial drug regimen. Prevalence rates, prevalence odds ratios, and logistic regression were used to determine the estimated risk for receipt of the CDC-ATS treatment regimen.


RESULTS
Of the 770 cases, 28.7% did not receive the CDC-ATS recommended drug regimen. Prevalence rates and odds for not receiving the recommended regimen were highest among persons of United States origin, Caucasians, females, persons under age 15, and persons from the southwest region of Virginia. Logistic regression indicated a slight increase in the estimated risk of not receiving the CDC-ATS regimen from a private physician (OR: 1.40; CI: 0.97, 2.04) when compared to a public physician.


RESULTS
Private tuberculosis care providers were less compliant with CDC-ATS guidelines than public tuberculosis care providers. Because providers did not follow the recommended treatment guidelines universally, it is advised that all tuberculosis care providers in Virginia would benefit from increased education regarding adequate treatment regimens for tuberculosis and the prevention of multidrug-resistant tuberculosis.
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D000293:Adolescent; D000328:Adult; D000368:Aged; D000904:Antibiotics, Antitubercular / Q000008:administration & dosage*; D002487:Centers for Disease Control and Prevention, U.S.; D002983:Clinical Competence; D004363:Drug Utilization / Q000592:standards*; D004502:Education, Medical, Continuing; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000453:epidemiology; D014481:United States; D014768:Virginia / Q000453:epidemiology
D000904:Antibiotics, Antitubercular