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Impact of the Patient-Provider Relationship on the Survival of Foreign Born Outpatients with Tuberculosis

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Journal of Immigrant and Minority Health Aims and scope Submit manuscript

Abstract

Background Managing tuberculosis in foreign born patients entails a complex interaction between patient and provider. Methods Using a retrospective cohort study and survival analysis, this study evaluates the impact of patient and provider factors on the survival of foreign born outpatients with active tuberculosis. The primary outcome of the study is 1 year all-cause mortality. Results In our cohort, patient-provider language discordance was associated with an increased risk of death [HR: 2.33; 95% CI: 1.39–3.88], while receiving treatment from a tuberculosis experienced physician [HR: 0.41; 95% CI: 0.22–0.77] and treatment in a dedicated tuberculosis clinic [HR: 0.53; 95% CI: 0.29–0.98] was associated with a lower risk of death. Discussion Patient-provider communication and health systems factors played a large role in the survival of our cohort of foreign born tuberculosis outpatients. These findings suggest that language barriers and the provision of care by experienced providers in specialized clinic settings may have important effects on health outcomes.

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Acknowledgements

This study was financially supported by the Doctors of Ontario via a Physician Services Incorporated research grant. The sponsor had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript. We are indebted to the following Ontario public health units for providing access to their tuberculosis patient data: Toronto; Peel; York; Durham, Hamilton, and Ottawa.

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Authors and Affiliations

  1. Division of Infectious Diseases, University Health Network, Toronto, ON, Canada

    Michael Gardam & Ann Campbell

  2. Department of Public Health Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Michael Gardam

  3. Department of Medicine, Division of Respirology, University of Toronto, Toronto, ON, Canada

    Geetika Verma

  4. Centre for Research on Inner City Health, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond St., Toronto, Ontario, Canada

    Jun Wang & Kamran Khan

  5. Department of Medicine, Division of Infectious Diseases, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada

    Kamran Khan

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  1. Michael Gardam
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  2. Geetika Verma
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  3. Ann Campbell
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  4. Jun Wang
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  5. Kamran Khan
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Correspondence to Kamran Khan.

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Gardam, M., Verma, G., Campbell, A. et al. Impact of the Patient-Provider Relationship on the Survival of Foreign Born Outpatients with Tuberculosis. J Immigrant Minority Health 11, 437–445 (2009). https://doi.org/10.1007/s10903-008-9221-8

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  • DOI: https://doi.org/10.1007/s10903-008-9221-8

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