title: Educational outreach to promote screening for tuberculosis in primary care: a cluster randomised controlled trial.
abstract: BACKGROUND
  Tuberculosis is re-emerging as an important health problem in industrialised countries. Uncertainty surrounds the effect of public-health control options. We therefore aimed to assess a programme to promote screening for tuberculosis in a UK primary health care district.
  
  
  METHODS
  In a cluster randomised controlled trial, we randomised 50 of 52 (96%) eligible general practices in Hackney, London, UK, to receive an outreach programme that promoted screening for tuberculosis in people registering in primary care, or to continue with usual care. Screening was verbal, and proceeded to tuberculin skin testing, if appropriate. The primary outcome was the proportion of new cases of active tuberculosis identified in primary care. Analyses were done on an intention-to-treat basis. This study was registered at clinicaltrials.gov, number NCT00214708.
  
  
  RESULTS
  Between June 1, 2002, and Oct 1, 2004, 44,986 and 48,984 patients registered with intervention and control practices, respectively. In intervention practices 57% (13,478 of 23,573) of people attending a registration health check were screened for tuberculosis compared with 0.4% (84 of 23 051) in control practices. Intervention practices showed increases in the diagnosis of active tuberculosis cases in primary care compared with control practices (66/141 [47%] vs 54/157 [34%], odds ratio (OR) 1.68, 95% CI 1.05-2.68, p=0.03). Intervention practices also had increases in diagnosis of latent tuberculosis (11/59 [19%] vs 5/68 [9%], OR 3.00, 0.98-9.20, p=0.055) and BCG coverage (mean BCG rate 26.8/1000 vs 3.8/1000, intervention rate ratio 9.52, 4.0-22.7, p<0.001).
  
  
  CONCLUSIONS
  Our educational intervention for promotion of screening for tuberculosis in primary care improved identification of active and latent tuberculosis, and increased BCG coverage. Yield from screening was low, but was augmented by improved case-finding. Screening programmes in primary care should be considered as part of tuberculosis control initiatives in industrialised countries.
authors.affiliation: Centre 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. Electronic address: c.j.griffiths@qmul.ac.uk.
authors.forename: Chris
authors.initials: C
authors.lastname: Griffiths
authors.affiliation: Centre 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.
authors.forename: Pat
authors.initials: P
authors.lastname: Sturdy
authors.affiliation: Department of Respiratory Medicine, Homerton University Hospital, Homerton Row, London, UK; Lower Clapton Group Practice, Lower Clapton Road, Hackney, UK.
authors.forename: Penny
authors.initials: P
authors.lastname: Brewin
authors.affiliation: Department of Respiratory Medicine, Homerton University Hospital, Homerton Row, London, UK.
authors.forename: Graham
authors.initials: G
authors.lastname: Bothamley
authors.affiliation: Centre for Health Sciences, Barts and The London, Queen Mary's School of Medicine and Dentistry, London, UK.
authors.forename: Sandra
authors.initials: S
authors.lastname: Eldridge
authors.affiliation: Centre for Health Sciences, Barts and The London, Queen Mary's School of Medicine and Dentistry, London, UK.
authors.forename: Adrian
authors.initials: A
authors.lastname: Martineau
authors.affiliation: Lower Clapton Group Practice, Lower Clapton Road, Hackney, UK.
authors.forename: Meg
authors.initials: M
authors.lastname: MacDonald
authors.affiliation: Centre for Health Sciences, Barts and The London, Queen Mary's School of Medicine and Dentistry, London, UK.
authors.forename: Jean
authors.initials: J
authors.lastname: Ramsay
authors.affiliation: Richmond Rd Medical Centre, Richmond Rd, London.
authors.forename: Suresh
authors.initials: S
authors.lastname: Tibrewal
authors.affiliation: City & Hackney Teaching Primary Care Trust, St. Leonard's Hospital, London.
authors.forename: Sue
authors.initials: S
authors.lastname: Levi
authors.affiliation: Centre for Infectious Diseases & International Health, Windeyer Building, Cleveland Street, London.
authors.forename: Ali
authors.initials: A
authors.lastname: Zumla
authors.affiliation: Centre 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.
authors.forename: Gene
authors.initials: G
authors.lastname: Feder
mesh_terms: D016000:Cluster Analysis; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008131:London / Q000453:epidemiology; D008403:Mass Screening / Q000379:methods*; D014374:Tuberculin Test / Q000706:statistics & numerical data*; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology