title: Do "Virtual" and "Outpatient" Public Health Tuberculosis Clinics Perform Equally Well? A Program-Wide Evaluation in Alberta, Canada.
abstract: BACKGROUND
  Meeting the challenge of tuberculosis (TB) elimination will require adopting new models of delivering patient-centered care customized to diverse settings and contexts. In areas of low incidence with cases spread out across jurisdictions and large geographic areas, a "virtual" model is attractive. However, whether "virtual" clinics and telemedicine deliver the same outcomes as face-to-face encounters in general and within the sphere of public health in particular, is unknown. This evidence is generated here by analyzing outcomes between the "virtual" and "outpatient" public health TB clinics in Alberta, a province of Western Canada with a large geographic area and relatively small population.
  
  
  METHODS
  In response to the challenge of delivering equitable TB services over long distances and to hard to reach communities, Alberta established three public health clinics for the delivery of its program: two outpatient serving major metropolitan areas, and one virtual serving mainly rural areas. The virtual clinic receives paper-based or electronic referrals and generates directives which are acted upon by local providers. Clinics are staffed by dedicated public health nurses and university-based TB physicians. Performance of the two types of clinics is compared between the years 2008 and 2012 using 16 case management and treatment outcome indicators and 12 contact management indicators.
  
  
  RESULTS
  In the outpatient and virtual clinics, respectively, 691 and 150 cases and their contacts were managed. Individually and together both types of clinics met most performance targets. Compared to outpatient clinics, virtual clinic performance was comparable, superior and inferior in 22, 3, and 3 indicators, respectively.
  
  
  CONCLUSIONS
  Outpatient and virtual public health TB clinics perform equally well. In low incidence settings a combination of the two clinic types has the potential to address issues around equitable service delivery and declining expertise.
authors.affiliation: Faculty of Medicine and Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.|School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Long
authors.affiliation: Faculty of Medicine and Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Courtney
authors.initials: C
authors.lastname: Heffernan
authors.affiliation: Clinical Epidemiology Unit, Department of Medicine, Memorial University, St. John's, Newfoundland, Canada.
authors.forename: Zhiwei
authors.initials: Z
authors.lastname: Gao
authors.affiliation: Faculty of Medicine and Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Egedahl
authors.affiliation: School of Public Health, University of Alberta, Edmonton, Alberta, Canada.|Alberta Health Province of Alberta, Edmonton, Alberta, Canada.
authors.forename: James
authors.initials: J
authors.lastname: Talbot
mesh_terms: D000293:Adolescent; D000328:Adult; D000416:Alberta / Q000453:epidemiology; D000554:Ambulatory Care Facilities; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care; D015397:Program Evaluation; D011634:Public Health; D019114:Remote Consultation / Q000379:methods*; D014376:Tuberculosis / Q000453:epidemiology / Q000628:therapy*; D055815:Young Adult