Quantifying the need for enhanced case management for TB patients as part of TB cohort audit in the North West of England: A descriptive study

Angela Tucker*, Jeniffer Mithoo, Paul Cleary, Mark Woodhead, Peter MacPherson, Tom Wingfield, Stefanie Davies, Carolyn Wake, Paddy McMaster, S. Bertel Squire

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Background: Patients with TB have diverse and often challenging clinical and social needs that may hamper successful treatment outcomes. Understanding the need for additional support during treatment (enhanced case management, or ECM) is important for workforce capacity planning. North West England TB Cohort Audit (TBCA) has introduced a 4-level ECM classification system (ECM 0-3) to quantify the need for ECM in the region. This study describes the data from the first 2 years of ECM classification. Methods: Data collected between April 2013 and July 2015 were used to analyse the proportions of patients allocated to each ECM level and the prevalence of social and clinical factors indicating need for ECM. Single variable and multivariable logistic regression models were constructed to examine the association between ECM level and treatment outcome. Results: Of 1714 notified cases 99.8% were assigned an ECM level: 31% ECM1, 19% ECM2 and 14% ECM3. The most common factors indicating need for ECM were language barriers (20.3%) and clinical complexity (16.9%). 1342/1493 (89.9%) of drug-sensitive, non-CNS cases completed treatment within 12 months. Patients in ECM2 and 3 were less likely to complete treatment at 12 months than patients in ECM0 (adjusted OR 0.47 [95% CI 0.27-0.84] and 0.23 [0.13-0.41] respectively). Conclusions: Use of TBCA to quantify different levels of need for ECM is feasible and has demonstrated that social and clinical complexity is common in the region. Results will inform regional workforce planning and assist development of innovative methods to improve treatment outcomes in these vulnerable groups.

Original languageEnglish
Article number881
JournalBMC Public Health
Issue number1
Publication statusPublished - 15 Nov 2017

Bibliographical note

Funding Information:
Jeniffer Mithoo is a PhD student funded by The National Institute of Health Research CLAHRC NWC (NIHR CLAHRC NWC). Jeniffer Mithoo contributed to the design and conduct of the study and the views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

Publisher Copyright:
© 2017 The Author(s).


  • Cohort audit
  • Cohort review
  • ECM
  • Enhanced case management
  • Social factors
  • TB
  • Treatment completion
  • Tuberculosis


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