ANALYSIS DEFAULT AND ANALYSIS DEFAULT AND TRANSFER CASES IN TRANSFER CASES IN

TUBERCULOSIS MAGEMENTTUBERCULOSIS MAGEMENT

A.Öngel, H.Arda, Ş.Bilgin, K.Oruç, G.Çetintaş, S.Ağca, H.H.C.C.ÇalışırÇalışır

.Süreyyapaşa  Chest Disease and Chest Surgery Training and Resarching Hospital

TURKISH THORACIC SOCIETY 10th ANNUAL CONGRESS 25-29 APRİL 2007

DOTSDOTS1. Sustained political commitment to increase human and

financial resources and make TB control a nationwide activity integral to the national health systemandardiz

2. Access to quality-assured TB sputum microscopy for case detection among persons presenting with, or found through screening to have, symtoms of TB.

3. Standardized short-course chemotherapy (SCC) for all cases of TB under proper case-management conditions including direct observation of treatment.

4. Uninterrupted supply of quality-assured drugs with reliable drug procurement and distribution.

5. Recording and reporting system enabling outcome assessment of every patient and asseement of the overall programe performance.

Treatment of Tuberculosis: Guidelines for National ProgrammesWHO/CDC/TB/2003

DOTDOT

SÜREYYAPAŞA TB REPORTING AND SÜREYYAPAŞA TB REPORTING AND RECODING SYSTEMRECODING SYSTEM

COHORT DEFINITION• Cohort: Common characteristics sharing and in adefinite

period following one group people

(birth in particular year, same district living, exposured to same agent )

• Study of following researching group beginnig of cause to occurcence disease.

• Problem of longer period following:Default of follow-up

Prof.Dr. Nazmi Bilir, Prof. Dr. Gül Ergör Saha AraştırmalarıAraştırma Yöntemleri

THORACIC CONGRESS 27 NİSAN 2005 Antalya

TREATMENT OUTCOMES • CURE: Patient who is sputum smear-negative in the last month of treatment and

on at least one previous occasion.

• TREATMENT FAILURE:Patient who is sputum smear-positive at 5 months or later during treatment.

• TREATMENT COMPLETED: Patient who has completed treament but who does not meet the criteria to be classified as a cure or a failure.

• TREATMENT SUCCESS: Completion cure and treatment completed patients.

• DIED: Patient who dies for any reason during the course of treatment.

• DEFAULT: Patient whose treatment was interrupted for consecutive months or more.

• TRANSFERED OUT: Patient who has been transferred to another recording unit and for whom the treatment outcome is not known.

Treatment of Tuberculosis: Guidelines for National ProgrammesWHO/CDC/TB/2003

City of detected uper of the 400 tuberculosis patients in 2005 City of detected uper of the 400 tuberculosis patients in 2005 ( Ministery of Health’s recording )( Ministery of Health’s recording )

population TB cases velocity

City Total cases *1000 (yüzbinde)

İSTANBUL 6.336 11.332 55,9

İZMİR 1.058 3.649 29,0

BURSA 862 2.362 36.5

ANKARA 685 4.139 15,9

ADANA 547 1.960 27,9

İÇEL 430 1.819 23,6

DİYARBAKIR 424 1.471 28,8

SAMSUN 414 1.193 34,7

Number of detected tuberculosis cases in our clinic (2004) :530Number of detected tuberculosis cases in our clinic(2005): 494

2004-2005 TB COHORT2004-2005 TB COHORT2004 2005

GENDER

n(%)

MAİL 300 (56.60) 262 (53.03)

FEMAİL 230 (43.40) 232 (46.96)

CATEGORYn(%)

I 347 (65.4) 308 (62,3)

II 74 (14) 74 (15)

III 101 (19) 105 (21,3)

IV 8 (1,6) 7 (1,4)

TOTAL 530 494

2004 TB COHORT TREATMENT OUTCOMES(n=530)

CAT. I CAT. II CAT. III CAT. IV TOTAL

CURE 309

(89.04%)

58

(71.60%)

82*

(82.17%)

1 451

(85.09%)

DEFAULT 32

(9.22%)

12

(14.81%)

16

(14.85%)

0 60

(11.13%)

TREATMENT FAILURE

1 9

(11.11%)

0 0 10

(1.88%)

DEATH 4

(1.15%)

2 2 0 8

(1.50%)

UNKNOWN 1 0 1 0 2

(3.77%)

TOTAL 347 81 101 1 530

*Treatment Completed

  CAT. I CAT. II CAT. III CAT. IV TOTAL

CURE 187(%60.71)

33(%44,59)

58*(%55.23)

6(%85.71)

284 (%57.48)

DEFAULT AND TRANSFERED OUT

98(%31.81)

27(%36,48)

32(%30.42)

0 157 (%31.78)

TREATMENT FAILURE

2(%0.64)

6(%8.10)

0 0 8 (%1.61)

DEATH 7(%2.27)

6(%8.10)

2(%1.90)

1 16 (%3.23)

UNKNOWN 14 2 13 0 29 (%5.87)

TOTAL 308 74 105 7 494

2005 TB COHORT TREATMENT OUTCOMESn=494

* Treatment completed

0

10

20

30

40

50

60

70

80

90

Cure Default andtransfer out

Treatmentfailure

Death

in one establishmentin two establishment

Compearing 2004 and 2005 years treatment Compearing 2004 and 2005 years treatment outcomesoutcomes

NEW SPUTUM SMEAR POSITIVE CASES OUTCOMES NEW SPUTUM SMEAR POSITIVE CASES OUTCOMES IN 2004 IN 2004

(Ministry of Health’s data)(Ministry of Health’s data)

TREATMENT OUTCOMES

n %

Treatment success 4.936 85

Default 267 4

Treatmnet failure 1 0

Death 161 3

Transfer out 271 5

In treatment 180 3

TOTAL 5.816

Notified treatment outcomes of tb dyspensary in Turkey (%)

• Default rates of different studies in our country (0-39.5)

• Transfered out (0-5.7)

Talay F., Kümbetli Ş.:İstanbul Eyüp Verem Savaş Dispanserinde Tüberküloz Hastalarının Tedavi Sonuçları ve Bu Sonuçları Etkileyen Faktörler Toraks Dergisi 2007;8(1):31-36

2004 and 2005 DEFAULT CASES

530 494

60(11,1%) 157 (31,9%)

43(71,6%) 86 (%54,8)

16(37,2%)) 79 (%91,8)

terk ve nakil giden 11%

Diğerleri89%

terk ve nakil giden 32%

Diğerleri68%

Treatment completed at tb dispensaryTreatment completed at tb dispensary

Default and Transfered outDefault and Transfered out

DEFAULT CAUSES2004 PATIENTS

• 43 of 60 patients called• 16 patients another city• 9 patients social security • 3 patients near tb dispansery • 4 patients drug side effects• 4 patients another disease• 2 patients ex• 5 default cases

2005 PATIENTS

• 86 of 157 cases called• 79 patients followed tb

dispancery becasuse of system chaining

• 1 patients drug side effect• 4 patient another disease• 2 patient default

16 Teratment Completed 16 Teratment Completed at tb dispensaryat tb dispensary

79 Teratment Completed 79 Teratment Completed at tb dispensaryat tb dispensary

2004-2005 YILI TERK VAKALARININ DİRENÇ SONUÇLARI

2004-2005 n (%) DEFAULT ANOTHER TOTAL

SENSITIVE 122 (21.2) 454 (78.8) 576

ANY RESISTANCE34 (20.9) 129 (79.1) 163

Subgroups

Except MDR drug resistanse

26 (26.2) 73 (72.8) 99

Total HR resistance

8(12.5) 56 (87.5) 64

DEFAULTabsence presence Total p VALUE

GENDER MALE 415 (76,7) 126 (23,3) 541 0,248

FEMALE 361 (79,9) 91 (20,1) 452

CATEGORY 1 510 (79,8) 129 (20,2) 639 0,057

2 112 (74,2) 39 (25,8) 151

3 146 (74,9) 49 (25,1) 195

4 8 (100,0) 0 (0) 8

AGE 35years and below 440 (80,3) 108 (19,7) 548 0,076

Older 35years 336 (75,5) 109 (24,5) 445

RESISTANCE absence 650(77,8) 185 (22,2) 835 0,675

presence 126 (79,7) 32 (20,3) 158

COMORBIDITY absence 664 (80,0) 166 (20,0) 830 0,003

presence 112 (68,7) 51 (31,3) 163

SMOKING Nonsmoker 442 (78,9) 118 (21,1) 560 0,770

20 p/y and less 187 (77,8) 54 (22,4) 241

20 p/y and more 147 (76,6) 45 (23,4) 192

RADIOLOGY limitted 550 (78,2) 153 (21,8) 703 0,334

diffuse 100 (82,6) 21 (17,4) 121

CAT II Except cat II 664 (78,9) 178 (21,1) 842 0,201

Cat II 112 (74,2) 39 (25,8) 151

TOTAL 776 (78,1) 217 (21,9) 993

B p value Odds Ratio

Confidence Interval

AGE 35 and under

35 upper 0,153 0,346 1,165 0,848-1,602

COMORBIDITE absence

presence 0,541 0,007 1,718 1,162-2,540

Logistic regretion analysis