The management for tuberculosis control in Greater London in comparison with that in Osaka City: Lessons for improvement of TB control management in Osaka City urban setting

Department of International Cooperation, The Research Institute of Tuberculosis, Matsuyama 3-1-24, Kiyose, Tokyo 2048533, Japan.
Health Policy (Impact Factor: 1.91). 08/2005; 73(1):104-23. DOI: 10.1016/j.healthpol.2004.11.006
Source: PubMed


The tuberculosis (TB) notification in Osaka City has been persistently high compared with other urban areas in Japan. Although the TB notification in Greater London has kept much lower level compared with that in Osaka City, it has been also persistently high compared with other urban areas in the UK. Nonetheless, the contexts of the two cities relating TB control programme as well as the epidemiological situation greatly vary; there must be some lessons to be learnt from each other to improve each TB control programme to tackle against TB more effectively. Comparing the epidemiological situation of TB in both cities, it is obvious that Osaka City suffers TB more than Greater London in terms of the TB notification rate. Concerning the context of the TB control programme, Osaka City has centralised approach with strong local government commitment; Greater London, on the other hand, has an approach that is greatly fragmented but coordinated through voluntary TB Networks. This paper aims to draw some constructive and practical lessons from Greater London TB control management for further improvement of Osaka City TB control management through literature review and interview to health professionals. TB epidemiology in Greater London shows distinct features in the extent of TB in new entrants and TB co-infected with HIV in comparison with those in Osaka City. TB epidemiology in Osaka City is to a great extent specifically related to homeless people whereas in Greater London, this relationship occurs to a lesser extent. Both areas have relatively high TB-notification rates compared with national figures, and they have "TB hot spots" where remarkably high TB-notification rates exist. TB control in Greater London is characterised with decentralised and devolved services to local government health authorities supplemented with co-ordinating bodies across sectors as well as across Greater London. Sector-wide TB Network as well as London TB Group (LTBG) and London TB Nurses Network are major key functioning bodies to involve relevant professionals as wide as possible. The specialist TB nurses play key roles for TB case management across Greater London, while in Osaka City, TB control is characterised with strong leadership and commitment of Osaka City Government for the TB control programme. The Osaka City Public Health Centre (PHC) takes initiatives to expand "Cohort Analysis and Case Management Conferences" at each of the 24 Ward Health and Welfare Centres as well as "DOTS Conferences" at hospitals for improvement of case management by physicians and nurses at hospitals as well as by the health centre staff. Public health nurses (PHNs) play very important roles for TB case management as frontline in Osaka City. Comparing the TB control in both cities, the following suggested recommendations are made to both cities for further improvement. Four suggested recommendations to Osaka City are: more resource re-allocation to community-based TB care than to hospital-based TB care should be done; Cohort Analysis and Case Management Conferences should be strengthened through involving more multi-disciplinary sectors; specialist TB PHN at each of the 24 Ward Health and Welfare Centres should be assigned in order to concentrate more on TB control activities; and accessibility to laboratory data such as drug susceptibility test for health centre staff should be improved. Two suggested recommendations to Greater London are: screening for TB high-risk group like homeless people should be strengthened, and regular sector-wide multi-disciplinary case conferences for proper case management should be strengthened.

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    • "Although the scope of this evaluation was TB services, structures and organisation within London, TB is nevertheless a global problem, with multidrug resistant outbreaks affecting comparable sized cities with relatively well-developed healthcare systems [8]. With the exception of one comparative study focusing on Osaka City, Japan and London [27], no published documentary evidence was found comparing London’s TB service models and infrastructure with those of similar urban contexts. By analysing approaches which have proved effective in other major cities, such as New York [21], useful insights and options may be gained for future management and organisation of London’s TB services. "
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    ABSTRACT: Background London has the largest proportion of tuberculosis (TB) cases of any western European capital, with almost half of new cases drug-resistant. Prevalence varies considerably between and within boroughs with research suggesting inadequate control of TB transmission in London. Economic pressures may exacerbate the already considerable challenges for service organisation and delivery within this context. This paper presents selected findings from an evaluation of London’s TB services’ organisation, delivery, professional workforce and skill mix, intended to support development of a strategic framework for a pan-London TB service. These may also interest health service professionals and managers in TB services in the UK, other European cities and countries and in services currently delivered by multiple providers operating independently. Methods Objectives were: 1) To establish how London’s TB services are structured and delivered in relation to leadership, management, organisation and delivery, coordination, staffing and support; 2) To identify tools/models for calculating skill mix as a basis for identifying skill mix requirements in delivering TB services across London; 3) To inform a strategic framework for the delivery of a pan-London TB service, which may be applicable to other European cities. The multi-method service audit evaluation comprised documentary analysis, semi-structured interviews with TB service users (n = 10), lead TB health professionals and managers (n = 13) representing London’s five sectors and focus groups with TB nurses (n = 8) and non-London network professionals (n = 2). Results Findings showed TB services to be mainly hospital-based, with fewer community-based services. Documentary analysis and professionals’ interviews suggested difficulties with early access to services, low suspicion index amongst some GPs and restricted referral routes. Interviews indicated lack of managed accommodation for difficult to treat patients, professional workforce shortages, a need for strategic leadership, nurse-led clinics and structured career paths for TB nurses and few social care/outreach workers to support patients with complex needs. Conclusions This paper has identified key issues relating to London’s TB services’ organisation, delivery, professional workforce and skill mix. The majority of these present challenges which need to be addressed as part of the future development of a strategic framework for a pan-London TB service. More consistent strategic planning/co-ordination and sharing of best practice is needed, together with a review of pan-London TB workforce development strategy, encompassing changing professional roles, skills development needs and patient pathways. These findings may be relevant with the development of TB services in other European cities.
    BMC Health Services Research 07/2012; 12(1):203. DOI:10.1186/1472-6963-12-203 · 1.71 Impact Factor
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    • "Christopher and Amir et al. reported similarly that the healthcare workers did not help the patients with their concerns and problems during the treatment, patients were not satisfied with the care provided [23,24]. In London, specialist TB nurses at the TB clinic assess new TB patient's needs for treatment after they have started treatment as soon as possible [25]. But in China, most of the healthcare workers are busy with their works, for example, providing effective medical treatment for patients, and thus with little time to communicate with the patients or focus on what the patients concern about. "
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    BMC Infectious Diseases 06/2010; 10(1):174. DOI:10.1186/1471-2334-10-174 · 2.61 Impact Factor
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    ABSTRACT: To obtain basic data about the present practices on storage and transport of isolated M. tuberculosis at public and private health institutions in Japan. Survey forms regarding the practices on storage and transport of isolated M. tuberculosis were distributed and collected by post-mail in January 2007 to 76 local public health institutions, 145 public health centres, and 150 public or private hospitals. The questionnaire was adopted from the guidelines proposed by the Ministry of Health, Labour, and Welfare in 2006 on storage and transport of isolated M. tuberculosis. The respondents of the survey were as follows: 96.1% (73/76) from local public health institutions, 93.8% (136/145) from public health centres, and 73.3% (110/150) from hospitals. In general, local public health institutions conformed well to the proposed standards, however public health centres and hospitals were not compliant to some standards. Based on the survey conducted on the practice of storage and transport of isolated M. tuberculosis, certain discrepancy was found among public health centres and hospitals.
    Kekkaku: [Tuberculosis] 09/2008; 83(8):591-8.
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