[Tuberculosis control in Kobe City--analyses of advisory contents and disqualified cases by integrated tuberculosis advisory committee].
The incidence of tuberculosis (TB) in Kobe City has been higher in comparison with that of Japan, thereby Kobe City ought to enforce anti-tuberculosis activities. Nine Wards public health departments of Kobe City used to convene their own tuberculosis advisory committees until April 1998, when a centralized committee was established to examine all TB patients. The new committee was authorized to issue clinical advice to registered physicians whenever necessary in order to improve treatment standard of TB. The author analyzed the contents of issued documents and observed any change in statistics before and after establishment of the committee. During the past 3 years, the new committee had sent 2,221 advisory documents to physicians, which occupied 35% of all 6,305 applied cases. Main suggestions included proper choice of anti-tuberculosis agents, adequate duration of treatment and reference to the results of laboratory examinations. In addition, 140 cases were rejected for medical expenses subsidy by TB Law to avoid unnecessary long-term treatment. Main reasons of rejection were long-term treatment despite negative bacilli too more than one year, continuous single INH administration following the completion of the standard treatment and unnecessary treatment for the cases with inactive findings on chest X-ray. Since the establishment of the integrated committee, the statistics of TB has demonstrated a significant decrease in the incidence and the prevalence of TB with its annual reduction of 5.6, and 11.5 per 100,000 respectively. The proportion of bacteriologically confirmed cases among newly registered patients has increased, and the diagnostic accuracy was improved due to the decrease in the unknown bacteriology case. The proportion of the case treated by INH alone fall down rapidly and it is lower than that of the whole country. These data demonstrate that the integrated tuberculosis advisory committee contributes to standardize anti-tubercular treatment through dissemination of proper guidance on TB diagnosis and treatment to all medical facilities in the city.
Shirai
Chika
C
Public Health Center of Kobe City, 5-1-1, Kumoi-dori, Chuo-ku, Kobe-shi, Hyogo 651-8570, Japan. dfbvv106@kcc.zaq.ne.jp
D026683:Advisory Committees; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D015995:Prevalence; D012015:Reference Standards; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*