A risk based framework for knowledge sharing in TB management: A case study in the United Kingdom and the Netherlands

Background:

TB is a serious, but treatable, infectious disease. TB prevalence is variable in EU countries ranging from near elimination (Netherlands) to a worrying increase (UK). Influencing factors include high risk groups (new entrants, refugees, homeless people and drug users), education programmes, multidrug-resistant tuberculosis (MDR-TB), and significant human and physical resources required during the entire TB patient pathway. Whereas high prevalence countries are improving their experience with TB, low prevalence countries have fewer opportunities for updating their knowledge. There is an urgent need to share knowledge and experience as the balance in prevalence is unlikely to stay the same due to changing labour markets, particularly from the Eastern Europe where MDR-TB is significant, numbers of foreign tourists and students, returning expats and home-students, plus the new immunosuppressive drugs which increase the risk of TB flaring up in older patients.

Objectives:

The aim of the study is to develop a framework by which the information and knowledge required to manage the entire TB patient pathway can be readily shared amongst TB professionals.

Methods:

The framework is developed based on empirical research conducted in two regions in the UK (Bradford) and the Netherlands (South Limburg) using Delphi methods for mapping work flows and associated data. The framework is based on a structured risk assessment model integrating clinical and public health requirements for information management for the detection, management and prevention of TB. The risk model is based on independent attributes assessed over the entire patient pathway.

Results:

The framework consists of a systematic and documented approach to dynamic risk assessment taking into account care pathways for TB, information flows required to enable those pathways to operate effectively and efficiently, and knowledge sharing for TB networks which will improve the timeliness of care.