Study: ERs are potential sources of TB transmission
Study: ERs are potential sources of TB transmission
Despite universal care, ERs used for primary care
The emergency room (ER) is a major point of contact between TB-infected patients, health care workers, and other patients at metropolitan health care delivery systems, say Canadian researchers. The clash of TB-positive patients with non-infected groups constitutes both a danger of infection transmission as well as an opportunity to seek out active cases of the disease.
"Increasingly," write the study authors, "in industrialized countries TB is an urban disease. Within cities, the disease thrives amongst the impoverished and those disconnected from mainstream society — groups that may not enjoy continuity of care with a personal physician and are more likely to use the emergency room for the delivery of primary care."
No lack of health care insurance
The findings were particularly striking within the context of a publicly funded health care system that provides universal care for Canadian citizens. "It’s interesting that we’re seeing this in the absence of any lack of health care insurance, says Richard Long, MD, from the University of Alberta in Edmonton and lead author of the study. "Of all the TB cases diagnosed over the five-year period in metropolitan Edmonton, about half visited one or another ER in the area for TB or for problems unrelated to TB during the six months immediately prior to diagnosis."
Of 250 patients who eventually received a diagnosis of TB, 117 (47%) made a total of 258 visits — 2.2 visits per case — to the ER in Edmonton, and the probability of a patient attending the ER increased as the date of TB diagnosis grew closer. Compared with ER non-attendees, ER visitors were significantly more likely to be older patients with risk factors for progression to active disease and for a high mortality rate.
"We were also surprised that so many TB patients used the emergency room more than once," Long adds, venturing that the problem may be widespread in Canada, despite the country’s universal health care coverage.
The findings don’t really come as a surprise, he notes. Researchers set out with the sense that the ER was used frequently by TB-infected individuals, many of whom are from low socioeconomic groups and do not have a personal physician.
"Even though we have universal insurance here, I guess there’s more to it than that; people might not be well-educated and understand how to attend to their health needs. When they get very sick, they end up in the emergency room."
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