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Tuberculosis is a re-emerging threat to public health in many developed countries, and primary care doctors are well placed to find it early and to make sure affected patients are treated. A simple educational intervention to encourage screening certainly worked in general practices in Hackney, where rates of tuberculosis are among the highest in the UK. A combination of education, support, computer prompts, and financial incentives increased rates of screening from 0.4% (84/23051) to 57% (13478/23573) of patients registering with a general practice in a cluster randomised trial.
General practices in the intervention group also did more tuberculin tests than controls and diagnosed more active cases (47% (66/141) v 34% (54/157); odds ratio 1.68; 95% CI 1.05 to 2.68). The overall yield from screening was low, however. Most of the improvements were due to better case finding in existing patients, not better screening of new registrants.
Still, the authors think their intervention could be a useful addition to local strategies against tuberculosis, particularly in inner city areas. It won't be enough on its own, however. The best way for developed countries to fight tuberculosis is to support control strategies well outside their own borders, says a commentary (pp 1493-4).