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Guidelines issued by the Committee on Infectious Diseases of the American Academy of Pediatrics mandate that all tuberculin skin test results be read by trained health care workers.1 This requirement necessitates a return visit to the practice site. Poor adherence to this follow-up in high-risk populations has been well documented in the literature.2 - 3 Reported adherence rates to tuberculin test readings range from 40% to 45% without an intervention.2 - 3 We describe a successful strategy for increasing adherence to follow-up for tuberculin skin test readings. Our study was conducted at an inner-city community health center serving an indigent minority population. Fifty-five percent of registered children were Hispanic, 44% were African American, and 50% were female. Forty-four percent of the children had no health insurance while 47% were covered by Medicaid.
We maintained a log of all tuberculin skin tests, including the dates of implantation and reading of results. A review of our logs for the period of January 1994 to January 1996 revealed that for the 3402 patients who received a tuberculin skin test, the adherence rate at the end of 72 hours to the tuberculin skin test reading was 54%. Our clinic's practice at this time was to instruct patients who received skin tests to return in 48 to 72 hours for skin test readings. In July of 1996, we implemented a new approach. All patients who received tuberculin skin tests were instructed to return in 48 hours for test readings. Those tested on a Friday were instructed to return in 72 hours (the following Monday). Patients who failed to return by the middle of the specified day were telephoned and instructed to come in later that day or the next day (72 hours later). Patients without telephones were sent a postcard instructing them to return for retesting. In July 1998, after 24 months of this new approach, we reviewed the results. Among the 4124 patients who received tuberculin skin tests the adherence rate at 48 hours was 59% but increased to 91% at 72 hours.
This strategy was highly successful in substantially improving the rate of adherence to tuberculin test readings. Other ambulatory health centers serving similar populations may wish to explore this approach.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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