Vulnerability Assessment and Enhanced Community-based Care and Management of Patients With Tuberculosis in Korea: A Crossover Design

Objectives: People-centered care and social protection are critical for improving tuberculosis (TB) treatment outcomes. This study aimed to evaluate whether a vulnerability assessment tool, developed for an enhanced community-based care and management (ECCM) program in 2 Korean cities, could predict...

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Vydáno v:Journal of preventive medicine and public health Ročník 58; číslo 3; s. 317 - 325
Hlavní autoři: Seo, Jeongmi, Jeong, Dawoon, Lee, In-Hyuk, Han, Jiyeon, Kwon, Yunhyung, Shim, Eunhye, Choi, Hongjo
Médium: Journal Article
Jazyk:angličtina
Vydáno: Korea (South) Korean Society for Preventive Medicine 01.05.2025
대한예방의학회
Témata:
Adult
Aged
case management
Community Health Services
Cross-Over Studies
Female
Humans
Male
Middle Aged
Original
Republic of Korea
Social Support
social vulnerability
Treatment Outcome
tuberculosis
Tuberculosis - drug therapy
Tuberculosis - therapy
vulnerable population
Vulnerable Populations
예방의학
Republic of Korea
Tuberculosis
Social vulnerability
Case management
Vulnerable population
ISSN:1975-8375, 2233-4521
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Abstract Objectives: People-centered care and social protection are critical for improving tuberculosis (TB) treatment outcomes. This study aimed to evaluate whether a vulnerability assessment tool, developed for an enhanced community-based care and management (ECCM) program in 2 Korean cities, could predict and improve final TB treatment outcomes based on patients’ vulnerability levels.Methods: Treatment outcomes in the ECCM group were compared with those in a control group, stratified by vulnerability level. During stage 1, one city served as the intervention region and the other as the control, with a crossover in stage 2. The vulnerability assessment included all notified patients with TB, and those identified as highly vulnerable in the intervention group received social support following a consultation with a case manager.Results: The vulnerability assessment tool demonstrated moderate predictive ability for unfavorable outcomes, with an area under the curve of 0.70 (95% confidence interval, 0.63 to 0.77). The patients with high vulnerability who received ECCM treatment demonstrated a 19.8-percentage point (%p) higher treatment success rate than the high vulnerability subcategory of the control group. ECCM also appeared to reduce loss to follow-up and TB-related mortality by 8.4%p and 7.3%p, respectively, although these findings should be interpreted with caution.Conclusions: The results suggest that providing social support tailored to patient vulnerability at the time of diagnosis could improve TB treatment outcomes.
AbstractList Objectives: People-centered care and social protection are critical for improving tuberculosis (TB) treatment outcomes. This study aimed to evaluate whether a vulnerability assessment tool, developed for an enhanced community-based care and management (ECCM) program in 2 Korean cities, could predict and improve final TB treatment outcomes based on patients’ vulnerability levels. Methods: Treatment outcomes in the ECCM group were compared with those in a control group, stratified by vulnerability level. During stage 1, one city served as the intervention region and the other as the control, with a crossover in stage 2. The vulnerability assessment included all notified patients with TB, and those identified as highly vulnerable in the intervention group received social support following a consultation with a case manager. Results: The vulnerability assessment tool demonstrated moderate predictive ability for unfavorable outcomes, with an area under the curve of 0.70 (95% confidence interval, 0.63 to 0.77). The patients with high vulnerability who received ECCM treatment demonstrated a 19.8-percentage point (%p) higher treatment success rate than the high vulnerability subcategory of the control group. ECCM also appeared to reduce loss to follow-up and TB-related mortality by 8.4%p and 7.3%p, respectively, although these findings should be interpreted with caution. Conclusions: The results suggest that providing social support tailored to patient vulnerability at the time of diagnosis could improve TB treatment outcomes.
Objectives: People-centered care and social protection are critical for improving tuberculosis (TB) treatment outcomes. This study aimed to evaluate whether a vulnerability assessment tool, developed for an enhanced community-based care and management (ECCM) program in 2 Korean cities, could predict and improve final TB treatment outcomes based on patients’ vulnerability levels.Methods: Treatment outcomes in the ECCM group were compared with those in a control group, stratified by vulnerability level. During stage 1, one city served as the intervention region and the other as the control, with a crossover in stage 2. The vulnerability assessment included all notified patients with TB, and those identified as highly vulnerable in the intervention group received social support following a consultation with a case manager.Results: The vulnerability assessment tool demonstrated moderate predictive ability for unfavorable outcomes, with an area under the curve of 0.70 (95% confidence interval, 0.63 to 0.77). The patients with high vulnerability who received ECCM treatment demonstrated a 19.8-percentage point (%p) higher treatment success rate than the high vulnerability subcategory of the control group. ECCM also appeared to reduce loss to follow-up and TB-related mortality by 8.4%p and 7.3%p, respectively, although these findings should be interpreted with caution.Conclusions: The results suggest that providing social support tailored to patient vulnerability at the time of diagnosis could improve TB treatment outcomes. KCI Citation Count: 0
People-centered care and social protection are critical for improving tuberculosis (TB) treatment outcomes. This study aimed to evaluate whether a vulnerability assessment tool, developed for an enhanced community-based care and management (ECCM) program in 2 Korean cities, could predict and improve final TB treatment outcomes based on patients' vulnerability levels. Treatment outcomes in the ECCM group were compared with those in a control group, stratified by vulnerability level. During stage 1, one city served as the intervention region and the other as the control, with a crossover in stage 2. The vulnerability assessment included all notified patients with TB, and those identified as highly vulnerable in the intervention group received social support following a consultation with a case manager. The vulnerability assessment tool demonstrated moderate predictive ability for unfavorable outcomes, with an area under the curve of 0.70 (95% confidence interval, 0.63 to 0.77). The patients with high vulnerability who received ECCM treatment demonstrated a 19.8-percentage point (%p) higher treatment success rate than the high vulnerability subcategory of the control group. ECCM also appeared to reduce loss to follow-up and TB-related mortality by 8.4%p and 7.3%p, respectively, although these findings should be interpreted with caution. The results suggest that providing social support tailored to patient vulnerability at the time of diagnosis could improve TB treatment outcomes.
Author Choi, Hongjo
Seo, Jeongmi
Shim, Eunhye
Han, Jiyeon
Lee, In-Hyuk
Kwon, Yunhyung
Jeong, Dawoon
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Issue 3
Keywords Tuberculosis
Social vulnerability
Case management
Vulnerable population
Language English
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SubjectTerms Adult
Aged
case management
Community Health Services
Cross-Over Studies
Female
Humans
Male
Middle Aged
Original
Republic of Korea
Social Support
social vulnerability
Treatment Outcome
tuberculosis
Tuberculosis - drug therapy
Tuberculosis - therapy
vulnerable population
Vulnerable Populations
예방의학
Title Vulnerability Assessment and Enhanced Community-based Care and Management of Patients With Tuberculosis in Korea: A Crossover Design
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