title: Impact of the patient-provider relationship on the survival of foreign born outpatients with tuberculosis.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Infectious Diseases, University Health Network, Toronto, ON, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Gardam
authors.forename: Geetika
authors.initials: G
authors.lastname: Verma
authors.forename: Ann
authors.initials: A
authors.lastname: Campbell
authors.forename: Jun
authors.initials: J
authors.lastname: Wang
authors.forename: Kamran
authors.initials: K
authors.lastname: Khan
mesh_terms: D000367:Age Factors; D002170:Canada; D015331:Cohort Studies; D003144:Communication Barriers; D023801:Directly Observed Therapy / Q000706:statistics & numerical data; D054242:Emigrants and Immigrants; D005260:Female; D015658:HIV Infections / Q000150:complications; D006304:Health Status; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D011369:Professional-Patient Relations; D012189:Retrospective Studies; D012737:Sex Factors; D016019:Survival Analysis; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000401:mortality; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000188:drug therapy* / Q000401:mortality*