CMAJ • September 26, 2006; 175 (7). doi:10.1503/cmaj.060124.
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Research

The impact of physician training and experience on the survival of patients with active tuberculosis

Kamran Khan, Ann Campbell, Tamara Wallington and Michael Gardam

From the Centre for Research on Inner City Health and the Department of Medicine, Division of Infectious Diseases, St. Michael's Hospital, University of Toronto (Khan), the Infection Prevention and Control Unit, University Health Network (Campbell, Gardam) and Toronto Public Health (Wallington), Toronto, Ont.

Correspondence to: Dr. Michael Gardam, 200 Elizabeth St., Rm. 3ES-428, Toronto General Hospital, Toronto ON M5G 2C4; fax 416 340-5047; michael.gardam{at}uhn.on.ca

Background: Physician training and experience may be important factors influencing treatment outcomes of patients with tuberculosis. We conducted an analysis to evaluate physician and patient characteristics and their association with the rate of death among tuberculosis patients.

Methods: We retrospectively reviewed all reported cases of active tuberculosis in Toronto between July 1, 1999, and June 30, 2002. We obtained extensive clinical data on cases as well as information on the training and clinical experience of treating physicians. We subsequently identified factors associated with patient mortality in a survival analysis.

Results: In a multivariable Cox regression analysis involving 1154 patients, factors associated with all-cause mortality included patient age (in years) (hazard ratio [HR] 1.05, 95% confidence interval [CI] 1.04–1.07, p < 0.001), use of directly observed therapy (HR 0.22, CI 0.13–0.39, p < 0.001), receipt of care from a physician experienced with tuberculosis (per case managed per year) (HR 0.98, CI 0.97–0.99; p = 0.01) and admission to hospital during the course of treatment (HR 15.44, CI 7.06–33.76, p < 0.001). Factors that were not associated with patient survival included whether the physician graduated from a foreign medical school, the physician's medical specialty and the number of years in clinical practice.

Interpretation: Physician experience with tuberculosis and use of directly observed therapy positively influenced the survival of patients with active tuberculosis in our setting.


Related Article

Physician experience, public health and the management of tuberculosis
Richard Long
Can. Med. Assoc. J. 2006 175: 759. [Full Text] [PDF]



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R. Long
Physician experience, public health and the management of tuberculosis.
Can. Med. Assoc. J., September 26, 2006; 175(7): 759 - 759.
[Full Text] [PDF]