Collaboration between municipal and specialist public health care in tuberculosis screening in Norway
1 Department of Pulmonary Medicine, St Olavs University Hospital, Po box, 3250, Sluppen, N-7006 Trondheim, Norway
2 Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, NO 7489, Trondheim, Norway
3 Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, NO 7489, Trondheim, Norway
4 City of Trondheim, Department of Infectious Disease Control, Municipality of Trondheim, Po Box 2300, Sluppen, 7004 Trondheim, Norway
BMC Health Services Research 2014, 14:238 doi:10.1186/1472-6963-14-238Published: 27 May 2014
About 90% of new tuberculosis (TB) cases in Norway appear among immigrants from high incidence countries. There is a compulsory governmental tuberculosis screening programme for immigrants; immigrants with positive screening results are to be referred from municipal health care to the specialist health care for follow-up. Recent studies of the screening programme have shown inadequate follow-up. One of the main problems has been that patients referred for follow-up have not attended their appointment at the specialist health care.
TB screening in the municipality of Trondheim is done by two different teams: the Refugee Healthcare Centre (RHC) screens refugees and the Vaccination and Infection Control Office (VICO) screens all the other groups. Patients with positive findings on screening are referred to the hospital’s Pulmonary Out-patient Department (POPD). The municipal and referral level public health care initiated a project aiming to improve follow-up through closer collaboration.
An intervention group and a pre-intervention control group were established for each screening group. During meetings between staff from the municipality and the POPD, inadequacies in the screening process were identified, and changes in procedures for summoning patients, and time and place for tests were implemented. For both the intervention group and the control group, time from referral until consultation at the POPD and number of patients that attended their first appointment were registered and compared.
In the VICO group, 97/134 (72%) of the controls and 109/123 (89%) of the intervention group attended their first appointment at the POPD after 30 weeks (median) and 10 weeks, respectively. In the RHC group 28/46 (61%) of the controls and 55/59 (93%) in the intervention group attended their first appointment after 15 and 8 weeks (median) respectively.
Increased collaboration between the municipal and specialist health care can improve the follow-up of positive TB screening results.