A survey of tuberculosis clinic provision in England and Wales.
BACKGROUND
This paper presents the methods and findings of a survey of current service configuration in tuberculosis screening, treatment and prevention in England and Wales, which was conducted as part of the development of the National Institute for Health and Clinical Excellence guidelines on tuberculosis for the country.


METHODS
A random sample of health protection units (HPUs) was surveyed (stratified geographically) in England. For Wales, National Health Service boundaries were used. There was a 100% sample of HPUs (33 clinics) in London and a 50% sample (81 clinics) outside London. The survey was completed by nurses in tuberculosis clinics. The questionnaire asked for details of caseload in terms of active disease (notified cases) and latent infection (screening and chemoprophylaxis), and the different types of specialist tuberculosis services offered.


RESULTS
Completed surveys were obtained from 67 of 81 clinics outside London and all 33 clinics in London. An association was found between the number of notifications and personnel, in line with previous British Thoracic Society guidelines. Higher notification areas, especially in London, provide additional specialist services such as human immunodeficiency virus/tuberculosis clinics and specialist paediatric clinics. Clinics in London also reported higher usage of incentives, directly observed therapy (DOT) and free prescriptions. Low notification areas outside London tend to see more patients at home for contact tracing and treatment review. However, there is considerable variation in the use of DOT and chemoprophylaxis that is not entirely explained by differences in caseload.


CONCLUSIONS
The survey showed that service configuration was organized in different ways in both high and low incidence areas. There is a need to share good practice and explore ways to configure services effectively in line with local needs.
Balasegaram
Sooria
S
National Collaborating Centre for Chronic Conditions, Royal College of Physicians, UK. sooria.balasegaram@hpa.org.uk
Grant
Robert
R
Ormerod
Peter
P
Mant
Jonathan
J
Hayward
John
J
Lowe
Derek
D
Story
Alistair
A
D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D003695:Delivery of Health Care; D004739:England; D019538:Health Care Surveys; D006801:Humans; D013222:State Medicine; D011795:Surveys and Questionnaires; D014376:Tuberculosis / Q000175:diagnosis / Q000628:therapy*; D014852:Wales; D000078329:Workforce