Case Burden on Local Managers and Treatment Supporters of Directly Observed Treatment Short-course for Patients with Tuberculosis
Date Issued
2012
Date
2012
Author(s)
Huang, Shiang-Yun
Abstract
Background: Tuberculosis (TB) is the second greatest infectious disease that caused the most deaths worldwide. World Health Organization (WHO) recommended the Directly Observed Treatment Short-course (DOTS) strategy to ensure the standard six-month treatment course for drug-sensitive TB disease. In Taiwan, local health center nurses, who serve as TB case managers, and treatment supporters retained by local governments, offer patient-centered service of directly observed treatments. This strategy facilitates success in TB treatments despite the long treatment course and considerable human resources. Therefore, appropriate manpower planning based on Taiwan’s TB epidemic is essential for TB control.
Objectives: To clarify whether the current quantities of frontline staffs for TB control meets the needs of the endemic status in Taiwan, this research aims to analyze the geographical distribution of TB cases, case burden (i.e. the caseloads and case visits) on local managers and treatment supporters and their case visit achieving rate, as well as the correlation between caseloads and treatment success rates and incidences of TB.
Methods: Study subjects were non-identifiable data of frontline personnel registered in TB case management system of Taiwan Centers for Disease Control. Descriptive statistics were adopted to analyze the caseload in each city and county, the quantities of local TB cases managers and treatment supporters and their case burden in June, 2012, while factors influencing the case visit achieving rates were on the basis of the linear regression analysis. The correlation between caseloads and treatment success rates of 2009 cohort of new TB cases and TB incidence variations from 2005 to 2010 by counties and cities were tested in addition.
Results: The quantities of local TB cases managers and treatment supporters were in line with the minimal requirements of distributional principles in most counties and cities in June, 2012. Both individual and average caseloads on each local TB case manager were significantly higher in Taipei City. From January, 2011 to June, 2012, the case visit achieving rate of local TB cases managers was negatively correlated with population density, while was positively correlated with the aging index in the correspondent cities and counties. For DOTS treatment supporters, the higher case direct observation rate was associated with higher caseloads, lower population density and lower patient uncooperative rate. Test results showed no significant correlation between the average caseload of local TB case managers and TB treatment success rate, the TB incidence rate, and the incidence variation.
Conclusion: This study demonstrated geographical differences in case burdens of frontline staff for TB control. The average caseload of local TB case managers in each cities and counties ranged from 1.0 to 35.0 in June 2012. The highest case burden and significantly inadequate manpower were found in Taipei City. The average caseload of DOTS treatment supporters had a reasonable, range from 1.0 to 7.6. Analysis revealed positive correlation between case direct observation rate and caseloads of DOTS treatment supporters. Further study may be required to see whether the reason was related to senior experience of treatment supporters or the payment institutions. The association between case visit achieving rate and caseloads of local TB case managers was not statistically significant (P=0.08), nevertheless, the negative correlation was still noteworthy as at 10% significance level.
Subjects
tuberculosis
local TB case managers
treatment supporters
caseload
case visit achieving rate
SDGs
Type
thesis
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