TUBERCULOSIS TESTING - PHYSICIAN ATTITUDES AND PRACTICE

Objective: To assess physician agreement with and adoption of American Academy of Pediatrics' (AAP) recommendations on tuberculosis screenin g in children. Design and Participants: Survey of random sample of 127 2 community pediatricians and family physicians (excluding academic in stitutions) in 4 mid-Atlantic states and the District of Columbia. Res ults: The response rate was 66%. Seventy-five percent of the responden ts were aware of the 1994 AAP screening recommendations. Most (64%) te st children at low risk periodically (at age 1 year, preschool age, an d adolescent age), and 81% test children at high risk annually. Eighty -one percent of the respondents estimated that 10% or less of their pa tients were at high risk for tuberculosis. Most use patient-specific f actors, geographic or community prevalence, or both as principal crite ria to determine risk. Eighty-seven percent used multiple-puncture tes ts in 1993; this declined to 55% in 1994. Multiple-puncture tests are still used exclusively by 29% of the respondents, Ninety-one percent o f those using multiple-puncture rests and 19% of those using the Manto ux test allow parents to read tile test reaction. Forty-six percent of the respondents; believed that if a return visit was required for rea ding the test reaction, 50% or less of their patients would return. On ly 22% of the respondents adhere to the 1994 AAP recommendations regar ding frequency, resting method, and reading the test reaction. Factors associated with adherence to AAP recommendations included physician a nd practice characteristics and knowledge of AAP recommendations. Conc lusions: Physician practice of tuberculosis testing varies widely; mos t do not adhere to the 1994 AAP recommendations. Most physicians vary the frequency and testing method based on a patient's risk status. The use of multiple-puncture tests has declined, although they are still widely used. Accurate reading of screening tests remains a major conce rn.