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Case Study 2 Tests of Association For Categorical Data

This study examined factors influencing successful treatment of pulmonary tuberculosis (PTB) patients in southern Taiwan. Medical records of all PTB patients reported between January and June 2018 were reviewed retrospectively for 15 months after diagnosis. Bivariate and multivariate logistic regression analyses were conducted to identify predictors of treatment success, defined as being cured or completing treatment. Potential predictors with p<0.1 in bivariate analysis were included in the multivariate model. The study aimed to determine patient and health system factors associated with successful PTB treatment.

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79 views

Case Study 2 Tests of Association For Categorical Data

This study examined factors influencing successful treatment of pulmonary tuberculosis (PTB) patients in southern Taiwan. Medical records of all PTB patients reported between January and June 2018 were reviewed retrospectively for 15 months after diagnosis. Bivariate and multivariate logistic regression analyses were conducted to identify predictors of treatment success, defined as being cured or completing treatment. Potential predictors with p<0.1 in bivariate analysis were included in the multivariate model. The study aimed to determine patient and health system factors associated with successful PTB treatment.

Uploaded by

saravanan kr
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Introduction

Factors influencing the successful treatment of infectious pulmonary tuberculosis


The abstract states that his study used a population based design. All PTB [pulmonary TB]
patients residing in southern Taiwan recorded in the tuberculosis registry from 1 January to
30 June 2018 were identified. Each patient’s medical record was requested from treating
hospitals and retrospectively reviewed for 15 months after the date PTB was confirmed.

METHODS
We carried out a population-based medical record review in southern Taiwan, where
the only chest specialty hospital geared towards specialised thoracic disease care,
mainly for TB, is located. Hospitals and primary practitioners that provided TB care in
the same region can be used as comparative care providers. Study areas include
Chiayi County, Chiayi City, Tainan County and Tainan City. As mandated by law in
Taiwan, all suspected and confirmed TB cases must be reported in a timely manner to
the national computerized registry maintained by the Taiwan Center for Disease
Control (CDC). Reporting of cases has been encouraged and reinforced through the
implementation of a no-notification, no-reimbursement policy and a notification-for-fee
policy since 1997. 7 We requested data on all suspected and confirmed TB patients
residing in the studied areas and recorded in the registry for the period 1 January to
30 June 2003. The study team, including four registered nurses (each with a
minimum of 6 years’ clinical experience), two head nurses (each with a minimum of 12
years’ clinical experience) and one pulmonologist, had undergone a series of training
courses designed to ensure proper validation of data consistency. Site visits were
arranged to review the medical record of each patient, and the 15-month follow-up of
medical records after start of treatment was reviewed.

Health care institutions


Health care institutions that had ever reported cases in the study areas included the
chest hospital, two academic medical centres, 11 regional hospitals and 15 district
hospitals and primary practitioners (district hospitals and primary practitioners are
regarded as being at the same level in terms of TB treatment). In Taiwan, institutions
are classified by the government as follows: ‘medical centres’ are health care, training
and research facilities that house over 500 acute-care beds; ‘regional hospitals’ have
no fewer than 250 acute care beds and are staffed by physicians of various
specialties with the purpose of providing health care services to patients and training
for specialists; and ‘district hospitals’ provide primary health care services similar to
those offered by primary practitioners but with the added availability of in-patient care.

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Infectious PTB
Infectious PTB is defined as sputum culture-confirmed disease caused by My co-
bacterium tuberculosis, or two sputum smear examinations positive for acid-fast
bacilli (AFB) or one positive sputum examination, radiological signs and a clinician’s
decision to treat.

Directly observed treatment


For directly observed treatment (DOT), a health worker or other trained person who is
not a family member watches as the patient swallows anti-tuberculosis medicines for
at least the first 2 months of treatment.1 DOT thus shifts the responsibility for cure
from the patient to the health care system. In Taiwan, whether or not the patient is
receiving DOT, TB is treated using WHO-recommended regimens; the initial phase
consists of 2 months of isoniazid (H), ethambutol (E), rifampicin (R) and pyrazinamide
(Z), followed by a 4-month continuation phase consisting of H, E and R
(2HERZ/4HER).

Treatment success
Treatment success is defined as a patient who has been cured or has received a
complete course of treatment. A cured case is defined as a PTB patient who has
finished treatment with a negative bacteriology result during and at the end of
treatment. A case recorded as completed treatment is defined as a PTB patient who
has finished treatment, but who has not met the criteria to be defined as a cure or a
failure.11,12

Ethical consideration
The study was approved by the Taiwan CDC. All staff members involved in the study
signed a statement of agreement to maintain patient confidentiality.

Data analysis
Bivariate analyses with 2 tests were used to compare differences in proportions of
dichotomous and categorical variables, which extracted potential predictors of
successful treatment. We then performed multivariate logistic regression analyses on
the potential predictors with P < 0.10 obtained from bivariate analyses. We
constructed a full model that included all the potential predictors identified through
bivariate analyses and then applied the forward substitution model building procedure
to construct a reduced model in which all the predictors were statistically significant.
Odds ratios (ORs) and 95% confidence intervals (CIs) of dichotomous and categorical
risk variables on the binary outcome variables were calculated. All analyses were
conducted using SPSS 10.0 software (SPSS Inc, Chicago, IL, USA), and all the tests
were performed at the two-tailed significance level of 0.05.

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References

Chung,Y-C. Chang, M-C. Yang†,Department of Internal Medicine, Hualien General Hospital,


Hualien, Institute of Health Care Int J Tuberc Lung Dis © 2007 The Union

Dawson, B and Trapp, R Basic &Clinical Biostatistics, 4th edition, Lange Basic Science, 2004
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World Health Organization. Tuberculosis Fact Sheet. Geneva,Switzerland: WHO.


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Migliori G B, Raviglione M C, Schaberg T, et al. Tuberculosis management in Europe. Task Force of


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World Health Organization. Global tuberculosis control. WHO Report 1999.


WHO/CDS/CPC/TB/99.259. Geneva, Switzerland: WHO, 1999.

Farah M G, Tverdal A, Steen T W, Heldal E, Brantsaeter A B, Bjune G. Treatment outcome of new


culture positive pulmonary tuberculosis in Norway. BMC Public Health 2005.

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