cohort study based in London. The study addressed how social factors influenced tuberculosis care. The study noted that, in relation to medication, there was no significant statistical difference between patients with mental health problems, the homeless and those who simply did not have anyone to remind them to take their medication. This point is relevant as some could presume that community psychiatric nurses or the homeless specialist nurses should only be involved in administering tuberculosis medication.
Craing et al (2007) found that there were associations between social risk factors and missed appointments and they suggest this shows a need for an outreach service by tuberculosis link workers. These link workers would look at social needs alongside the patient's other needs.
Craing et al (2008) then explored the impact of a tuberculosis link worker. This again was a prospective cohort study and evaluated the new service role of tuberculosis link worker who was a social worker in this study. The authors discussed the need for skill mixes within clinical teams when managing the increasing incidences of tuberculosis. Craing et al's (2008) study concluded that link workers were effective in enabling integrated health and social care as they worked with both patients and the relevent providers in ensuring a holistic care approach.
Both of Craing et al's studies were carried out in London which has the UK's highest rates of tuberculosis; therefore tuberculosis link workers would be valid in this area. In other areas the use of separate link workers would not be justified but integrated teams would be.
Implications for community nurses
Tuberculosis is an important public health issue and is high on the DH agenda because of the increasing incidence of tuberculosis in the UK.
This literature review has addressd the issue involving tuberculosis patients and district nursing teams. It has identified that adherence is a major problem when looking after these patients and that district nursing teams have a vital role to play within this area. It is also apparent that knowledge of tuberculosis needs to be increased among nursing staff. This is especcially pertinent as tuberculosis is a notifiable disease and the consequences of tuberculosis not being treated correctly not only affect the patient but also the wider commuinity. Improved awareness can be achieved through the media and community groups, and through undergraduate, postgraduate and continuing professional education.
With greater professional awareness district nurses will be able to contribute to the long-term goal of the reduction and ultimately elimination of tuberculosis in this country.