S.A. Sterlikov1, S.G. Rudnev2, O.V. Obukhova1
1 Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation, Moscow
2 Research Institute of Phthisiopulmonology, First Moscow State Medical University named after I.M. Sechenov, Moscow
Abstract. Background. Fluorography is the main method
of detecting tuberculosis in the Russian Federation. However, efficiency
of this method is insufficient. The detection rate of TB patients with
fluorography in 2009-2012 was 0.79-0.71 per 1,000 patients (at optimum
1-2 per 1,000). Double reading of chest films is one of the methods to
improve efficiency of fluorography.
The aim of the study was to analyze medical and economic efficiency of organizing double reading of chest films.
Methods. Survey of 236 primary health care organizations was
conducted in 2009. Double reading of chest films was used in 8.9% of
medical institutions serving 13.7% of the population sample. Single
reading was used in 25.4% of the institutions for 27.7% of the
population sample. The remaining institutions used the dual reading of
chest films.
The study shows that universal implementation of the double reading
of chest films in Russia can improve detection of tuberculosis through
routine chest X-rays by 19% (up to 0.94 per 1,000 tested), as well as
increase the share of newly TB cases detected during routine chest
X-rays by 19% (up to 65.9%).
It has been calculated that prime cost of X-ray per capita will
increase from 46.12 to 49.51 rubles (1.54 to 1.65 USD) (in 2009 prices),
while the total primecost of detecting a TB patient with fluorography
will decrease by 5663.86 rubles (188.8 USD) (9.8%) and will add up to
52334.39 rubles (1744.48) USD per patient.
Scope of application: primary health care.
Keywords: routine examinations for tuberculosis;
fluorography; double reading; economic efficiency of fluorography; prime
cost of TB detection per patient.
References
-
Veybert RA. Usage of various variants of double and triple assessment
to improve detectability of tuberculosis and the other pulmonary
diseases. Cand.Med.Sci [thesis]. Moscow. 1975. 19 p. (In Russia).
-
Ivanova ÅS. New cases of pulmonary tuberculosis in adults and
optimization of methods for its early detection. Dr.Med.Sci [thesis].
Moscow. 1983. 45 p. (In Russia).
-
Nezlin SE, Oyfebakh MI. Timely detection of pulmonary tuberculosis in
adults. Manual on tuberculosis, 4 volumes. VL. Eynis, editor. Moscow:
Medgiz; 1962. Vol. 4. P. 179-213. (In Russia).
-
On setting labor quotas for the work of medical workers in fluorography
rooms: the Letter of the Ministry of Health of the Russian Federation
of October 28, 1992 ¹21-01-983 [Internet] 1992 [cited 2013 Aug 05].
Available from:
http://www.lawrussia.ru/texts/legal_456/doc456a408x192.htm (In Russia).
-
Gurevich GL, Skryagina EM, Kalechits OM, Bogomazova AV, Astrovko AP,
Zhvalevskaya YaI, et al. Indicator and criteria for assessing the
epidemic situation on tuberculosis and efficiency of TB control
facilities. Minsk 2008. 17 p. (In Russia).
-
On measures to strengthen the fight against tuberculosis: the Order of
the Ministry of Health of the USSR of September 07, 1972 ¹747 [Internet]
1972 [cited 2013 Aug 05]. Available from:
http://www.jurbase.ru/texts/sector173/tez73453.htm (In Russia).
-
Rudoy NM. Organization of timely detection of patients. Pulmonary
tuberculosis. AG. Khomenko, editor. Moscow: Meditsina; 1981. 466 p. (In
Russia).
-
Tuberculosis in the Russian Federation 2011. Analytical review of
statistical indicators used in the Russian Federation and the world.
Moscow. 2013. 280 p. (In Russia).
-
Cherednikova AA, Ivanov SI. Health assessment and performance of
medical X-ray equipment operating in health facilities of Ryazan region.
Rossiyskiy mediko-biologicheskiy vestnik. [Online Serial
Journal] [cited 2013 Aug 05]. 2010; (1). Available from:
http://www.vestnik.rzgmu.ru/data/files/2012/12/%D0%A7%D0%B5%D1%80%D0%B5%D0%B4%D0%BD%D0%B8%D0%BA%D0%BE%D0%B2.pdf
(In Russia).
-
Shilova MV. Tuberculosis in Russia in 2009. Moscow: Prima Publishing House Ltd; 2010. 192 p. (In Russia).
-
Birkelo CC, Chamberlain WE, Phelps PS. Tuberculosis case finding: a
companion of the effectiveness of various roentgenographic and
photofluorographic methods. Journal of the American Medical Association. 1947; 133: 359-366.
-
Eley AJ, Gough JH. An investigation into the reliability of single reading of miniature chest films. Tubercle. 1960; 41(6): 435 – 440.
-
Groth-Petersen E, Løvgreen A, Thillemann J. On the reliability of the
reading of photofluorograms and the value of dual reading. Acta Tuberculosis Scandinavica. 1952; 26: 13-37.
-
Groth-Petersen E, Møller V. Observer error in the interpretation of
photofluorograms and the value of dual reading in the Danish mass
campaign. Acta Tuberculosis Scandinavica. 1955; 30: 209-230.
-
Holm S, Nielsen H, Møller V, Winge K. On dual reading of photofluorograms. Acta Tuberculosis Scandinavica. 1954; 30: 63-81.
-
Williams RG. The value of dual reading in mass radiography. Tubercle. 1958; 39 (6): 367 – 371.
-
Yerushalmy J, Harkness JT, Kennedy BR. The role of dual reading in mass radiography. Am. Rev. of Tuberc. 1950; 61: 443-464
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