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


CONCLUSIONS
Physician experience with tuberculosis and use of directly observed therapy positively influenced the survival of patients with active tuberculosis in our setting.
Khan
Kamran
K
Centre for Research on Inner City Health and the Department of Medicine, Division of Infectious Diseases, St. Michael's Hospital, University of Toronto, Toronto, Ont.
Campbell
Ann
A
Wallington
Tamara
T
Gardam
Michael
M
D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D019090:Case Management; D002983:Clinical Competence; D023801:Directly Observed Therapy / Q000706:statistics & numerical data*; D005260:Female; D005550:Foreign Medical Graduates; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000592:standards* / Q000706:statistics & numerical data; D012044:Regression Analysis; D012189:Retrospective Studies; D016019:Survival Analysis; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000401:mortality*