LONG-TERM HOSPITALIZATION FOR TUBERCULOSIS-CONTROL - EXPERIENCE WITH A MEDICAL-PSYCHOSOCIAL INPATIENT UNIT

Context.-Patients with tuberculosis (TB) who are nonadherent to therap y or have complicated medical or social problems pose a threat to publ ic health. In some cases, hospitalization may be a necessary component of a comprehensive TB control program. Objective.-To describe experie nce with a new inpatient program for TB control.Design.-Retrospective review. Setting.-Eighteen-bed, secure, TB treatment unit in a state pu blic health hospital providing a spectrum of acute and chronic care se rvices. Patients.-Patients with known or suspected TB who were unable to be treated as outpatients and were hospitalized from 1990 through 1 995. Interventions.-voluntary or involuntary hospitalization, with med ical, psychosocial, and legal services. Main Outcome Measures.-Admissi ons, treatment completion, and disposition. Results.-A total of 166 pa tients with a confirmed diagnosis of TB accounted for 214 hospitalizat ions for TB. The mean age was 42 years, 132 (79.5%) were men, 84 (50.6 %) were nonwhite, and 45 (27.1%) were foreign born. At the time of adm ission, 58 patients (34.5%) were homeless, 116 (69.9%) had a history o f abuse of alcohol or other drugs, and 46 (31.7%) were positive for hu man immunodeficiency virus. The mean length of stay was 119.7 days (me dian, 70 days; range, 7-656 days), and was higher among homeless patie nts than nonhomeless patients (168.8 vs 93.4 days). Of 48 patients (28 .9%) who were admitted involuntarily, 21 required long-term confinemen t under court order. Admission indications (not mutually exclusive) ch anged over 5 years: nonadherence decreased (95% to 34%), medical compl exity increased (14% to 77%), short-term isolation increased (19% to 3 9%), and involuntary admission decreased (54% to 13%). Of 157 patients with positive cultures for Mycobacterium tuberculosis, 36 (23.1%) wer e resistant to at least 1 drug, including 16 who were multidrug resist ant. A total of 123 patients (74.7%) were discharged to an outpatient setting to complete therapy, 40 (24.1%) required inpatient care to com plete therapy, and 3 died (1 from TB) before discharge. Conclusions.-A high proportion of patients with TB who failed outpatient therapy com pleted treatment in a combined medical and psychosocial inpatient unit . During the 5-year study period, involuntary admissions decreased and most patients completed therapy as outpatients. In Massachusetts, thi s program plays an important role in protecting public health and in p roviding specialized medical management for patients to complete thera py in a safe and supportive environment.