Background and Purpose:
The Jefferson Center for Refugee Health (JCRH), a component of Jefferson Family Medicine Associates (JFMA), is the first and largest single provider of refugee health in Philadelphia; over 1,000 refugee primary care visits are provided annually. Refugee patients are disproportionately affected by latent tuberculosis infection (LTBI) compared to the general population of the United States; and though treatment of LTBI is highly effective at reducing conversion to active tuberculosis (TB), completion rates among the foreign-born are reported to be less than 50%. To establish baseline LTBI incidence and treatment completion rates for our refugee population, the JCRH conducted a retrospective chart review for the time period of 2007-2011. We found that 23.1% of incoming patients to the center had LTBI and among patients started on LTBI treatment 33.1% completed therapy. Using these rates as a foundation, we developed an interdisciplinary public health model to improve care.
Methodology: Our model consists of pharmacy, medicine, nursing, social work, and community outreach to improve the LTBI completion rates of our patients. Pharmacy serves as a central point of contact for model coordination and execution which involves prospective chart review, initial face-to-face counseling, phone follow up, community monitoring, plus collaboration with the Philadelphia Department of Health and local resettlement agency.
Results: Between September 2012 and March 2014, a total of 526 new patients were seen at the JCRH. Ninety patients were diagnosed with LTBI, representing an incidence rate of 17%. Seventy –three patients successfully started LTBI treatment; 44 completed treatment, 29 failed to complete treatment. The overall completion rate for the 18-month time period was 60%, representing an almost 2-fold improvement over baseline rates.
Recommended CitationO'Leary, PharmD, Christine; Scott, MD, Kevin; Altshuler, MD, Marc; Kitagawa-James, RN, BSN, Karen; and Hervada-Paige, MSS, Maria, "Unique Interdisciplinary Public Health Model Doubles Latent Tuberculosis Infection Treatment Completion of Refugee Patients in a Large Metropolitan Area" (2014). Department of Family & Community Medicine Presentations and Grand Rounds. Paper 37.