CDC History of Tuberculosis Control - Medical and Public Health ...

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and the distribution of print-based materials. Educational films, then later videotapes, were developed and distributed, but often these materials had a very limited distribution because of the costs of the films and tapes and the limited availability of audiovisual equipment for viewing. Today, through the availability of technology and reduced production costs, we have a vast array of materials and courses that are distributed through a wide variety of media. Some of the media include print-based curricula with slides (e.g., the Core Curriculum on Tuberculosis); CD ROM (e.g., Tuberculosis: An Interactive CD ROM for Clinicians); satellite-based courses (e.g., the Satellite Primer on Tuberculosis); videotapes (e.g., the Skin Testing Video); audiotapes (e.g., the TB voice information system); and Internet-based courses (e.g., the Web-Based Self-Study Modules). With the use of satellitebased courses, instructors can simultaneously reach thousands of health care providers in every US state and territory with accurate, upto-date information. Reduced costs for the reproduction of videotapes and CD ROMs allow for wide-spread distribution of materials. In addition, the Internet allows for distribution of materials and courses to audiences we may have never reached before, both professionally and geographically, at no additional cost after initial production. Print-based materials are also accessible in a Notable Events in TB Control 55 variety of ways. Hard copies can be ordered by mail, by telephone, by fax, or through the Internet online ordering system. Materials can also be downloaded and printed from the Internet. The electronic files of the materials available through the Internet can also be utilized as the basis for adaptation and development of site-specific or populationspecific materials. Another big change in TB training and education is in the methodologies used to influence health care providers’ implementation of TB recommendations. In the past, the primary method utilized was information dissemination to increase the health care providers’ knowledge of the recommendations. However, we know that information alone is not sufficient to change the practice of many health care providers. In addition to knowledge or information, health care providers must be persuaded to try the new recommendations. This persuasion can occur if the health care provider thinks that the recommendations provide an advantage (is it better than what it’s replacing?); is compatible with the current system (no major conflicts created in the current system to implement); is not too complex (how hard is it to do or use?); can be tried beforehand (can I try it before I decide to really use it with patients?); can be observed (can I actually see the result of using this innovation?); and is flexible to being adapted to the current system. After being persuaded that there is an advantage to the new recommendation, health care providers must progress through a decision process (adopt or reject), then to implementation, then to continued, ongoing use of the recommendations. Behavioral theories and models can be utilized to guide the development of educational and training interventions to aid in this progress. Interventions such as academic detailing and the use of opinion leaders can be utilized to facilitate the progress. For current and future efforts, utilization of
ehavioral science and implementation of operational research are essential for developing effective interventions in TB communications, training, and education. With decreasing TB cases in the United States, it becomes even more important to be vigilant, efficient, and effective in our efforts to keep health care providers aware of recommendations, and utilizing them appropriately. Note: Please feel free to use the DTBE Educational and Training Materials order form included in this issue. Materials can also be ordered from the DTBE web site at http:// www.cdc.gov/nchstp/tb TB Control in the Information Age by Jose Becerra, MD, MPH Chief, Computer and Statistics Branch “TRS is a computer-based system devised to furnish current information on clinical management of patients and upto-date statistical summary reports for public health administrative purposes.” - Tuberculosis Branch, State and Community Services Division, National Communicable Disease Center, Sept. 1969. Thus was recorded one of the first iterations of an electronic information management system for the purpose of tracking the epidemiology and clinical management of TB in the United States. The Tuberculosis Record Service (TRS), a mainframe system using punch cards and computer tapes for data processing, was a predecessor of the DOS-based SURVS-TB (Software for Expanded Tuberculosis Surveillance). SURVS-TB, a microcomputer system depending on mailed diskettes for data transfer, and the Tuberculosis Database System (TBDS), a patient management recordkeeping system, were used until 1998 when the Tuberculosis Information Management System (TIMS) was TB Control at the Millennium 56 implemented. Regardless of names and versions, TB information management systems pursue the same general objective: the use of meaningful data, that is, intelligence-added data, to perform organizational work and monitor outcomes. TIMS is an integrated client-server application in Windows, meaning that many users (“clients”) may simultaneously access a fully relational database residing in a secure server within a computer network, using the Microsoft Windows graphics user interface. TIMS has replaced the mailing of diskettes with dedicated modem communications for data transfer purposes. Furthermore, TIMS allows the generation of surveillance data from the patient management module integrated within TIMS. Soon, TIMS will also be able to import surveillance data from other systems to completely eliminate the need for double data entry. However, when TIMS was originally designed, the Internet revolution that nowadays dominates the informatics world was just beginning. The World-Wide Web model, wherein interactive and secure data transactions are conducted using a common viewer or “browser,” regardless of the original platform in which an application is developed, poses new opportunities and challenges to the future of TIMS. Among these challenges are 1) the speed with which information technology is being adopted (and abandoned); and 2) the call for fully “integrated” information systems. The transition of TIMS into a Web-enabled
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Christmas Seal Campaign, 1945. Reco
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A Century of Notable Events in TB C
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