Search Results

7.The effectiveness of a clinical pathway checklist for pulmonary tuberculosis in improving the appropriateness of care and the issues with its use among resident physicians at the family medicine clinic of the Philippine General Hospital

The Filipino Family Physician 2010;48(1):16-24

Background: Pulmonary Tuberculosis has been a major health problem despite major efforts for its control. Quality assurance tools such as the clinical pathway may aid in promoting quality health care delivery to meet standards of care for PTB. Objectives: This study was conducted to determine the effectiveness of providing clinical pathway checklist for PTB in improving the appropriateness of care as compared to those without checklist and the issues with its use among residents at the Family Medicine Clinic of the Department of Family and Community Medicine at UP-PGH. Methodology: The Family Medicine Clinic was the setting of the study and the DFCM resident rotators for August-September, 2009 were the subjects. PTB cases seen during the 42 clinic days were randomized into groups with PTB clinical pathway checklist and without checklist. Chart audit was done based on the clinical pathway for PTB. The mean percentage scores served as a measure of the appropriateness of care. These were compared among the two groups based on the following parameters: clinical evaluation, assessment, health counseling, medications and monitoring and the overall appropriateness of care. A focus group discussion was done to identify issues with the use of the clinical pathway checklist. Results: The clinical pathway checklist significantly improved the appropriateness of care in the following parameters, clinical evaluation (86.40 versus 75.54) at P value 0.004; health counseling (71.98 versus 56.22) at P value 0.007; monitoring and follow-up (62.2 versus 37.98) at P value <0.01 and in the overall appropriateness of care (78.24 versus 71.05) at P value 0.0002. The parameters of care in terms of laboratory evaluation and diagnosis for both groups, and clinical evaluation in the group with clinical pathway checklist were able to meet the set standard of 80 percent. Issues identified with the use of PTB clinical pathway checklist were physician characteristics, clinician time commitment, applicability to setting and financial resources. Conclusion: The PTB clinical pathway checklist was effective in improving the appropriateness of care in all parameters and was significant in terms of clinical evaluation, laboratory evaluation, health counseling, monitoring and follow-up and the overall appropriateness of care. Issues identified with the use of clinical pathway should be considered prior to pathway development and implementation.
PULMONARY TUBERCULOSIS

8.Accuracy of Nasopharyngeal Aspirate GeneXpert Compared to Gastric Aspirate TB Culture and GeneXpert in Diagnosing Pulmonary Tuberculosis in Pediatric Patients

Joy L. Morcilla ; Ma. Liza Antoinette M. Gonzales ; Anna Lisa T. Ong-Lim

Pediatric Infectious Disease Society of the Philippines Journal 2021;22(2):20-31

Background: Pulmonary TB in children remains to be a burden in the Philippines. Diagnosis remains to be a challenge for pediatricians due to its paucibacillary nature, difficulty in obtaining specimens, cost of test as well as the varied sensitivity of the different tests available. Gastric aspirate (GA), commonly used for bacteriological diagnosis of pulmonary tuberculosis (PTB) in children, involves an invasive procedure that may cause discomfort and sometimes require admission. Nasopharyngeal aspirate (NPA), on the other hand, can be easily and non-invasively obtained but is currently not a recommended specimen for testing for PTB. Objectives: This study aims to determine the accuracy of NPA GeneXpert in diagnosing PTB among pediatric patients 0-18 years old with presumptive TB using GA GeneXpert as the initial screening test and GA TB culture as gold standard. Methodology: This prospective, cross-sectional diagnostic study involved collection of single NPA and GA specimens for GeneXpert and TB culture in 100 patients with presumptive PTB seen at a tertiary government hospital in the Philippines. Results: Of the one hundred pediatric patients (mean age 6 ± 5.63 years) enrolled, 50 were clinically diagnosed PTB, 16 bacteriologically-confirmed and 34 were not PTB disease. Sensitivity, specificity and predictive values with 95% confidence intervals of the NPA GeneXpert were determined compared to GA GeneXpert and GA culture. Sensitivity, specificity, positive and negative predictive values of the NPA GeneXpert compared to GA GeneXpert were 70%, 96.67%, 70% and 96.67%, respectively. While NPA GeneXpert compared to GA TB culture were 40%,91.58%, 20% and 96.67%, respectively. Conclusion GeneXpert testing on a single NPA specimen is a highly specific and rapid test that can be used to diagnose PTB in pediatric patients, particularly where gastric aspiration or mycobacterial culture is not feasible.
Tuberculosis, Pulmonary