The ascertainment and management of tuberculosis in Tayside, Scotland during 1993-94.

OBJECTIVE: To evaluate whether utilising a database of dispensed prescriptions for anti-tuberculous chemotherapy could improve case ascertainment compared to standard methods. A further objective was to assess whether cases were managed according to standard guidelines. DESIGN: Retrospective case note audit. SETTING: Tayside, Scotland SUBJECTS: Patients identified by conventional (i.e. SMRI diagnostic codes, notifications to the Health Board, microbiology and pathology reports) and the data base (MEMO) as potentially having tuberculosis and receiving treatment between 1st January 1993 and 31st December 1994. One hundred and ninety one potential cases were identified. One hundred and twenty two case notes were obtained for review. Eighty eight of these were initially thought to have tuberculosis and the results below refer to these 88 cases. RESULTS: MEMO identified 43 cases not found by conventional methods. Cases identified by MEMO were more likely to have been managed as outpatients and less likely to have positive microbiology than cases identified by conventional means. Only 26 cases were notified to the Health Board, including all smear positive cases. CONCLUSIONS: Notification of tuberculosis continues to be incomplete. Use of the MEMO system almost doubled case ascertainment. The absence of a firm diagnosis may lead to a reluctance to notify cases being treated as tuberculosis.