Newly diagnosed tuberculosis in inner-city Chicago: the pulmonary fellow perspective.

摘要

BACKGROUND: The extent to which pulmonary fellows encounter patients with newly diagnosed tuberculosis during their 3-year training program in large metropolitan areas in the USA where active tuberculosis is still relatively common is uncertain. OBJECTIVES: To characterize clinical encounters of pulmonary fellows with patients with newly diagnosed tuberculosis at a large university-based training program in inner-city Chicago over a 3-year period. METHODS: A retrospective review of medical records of patients with newly diagnosed tuberculosis at the University of Illinois Medical Center at Chicago outpatient clinics (UMC) and the City of Chicago Department of Public Health Uptown Neighborhood Health Center Tuberculosis Clinic (CDPH) between 1999 and 2001 was conducted. A pulmonary fellow encounter rate (PFER) was derived as the average number of patients with newly diagnosed tuberculosis seen by a pulmonary fellow per month over the 3-year study period in each institution. RESULTS: We found that 9 pulmonary fellows diagnosed, treated and followed all 80 patients with newly diagnosed tuberculosis seen at CDPH over the 3-year study period. By contrast, they evaluated only 14 patients with newly diagnosed tuberculosis and followed 2 of them regularly at UMC (p < 0.05). PFER was 2.96 at CDPH and 0.52 at UMC (p < 0.05). Adverse events ascribed to anti-tuberculosis drugs were observed more frequently in patients seen by pulmonary fellows at CDPH than at UMC (p < 0.05). CONCLUSIONS: Pulmonary fellows are more likely to encounter patients with newly diagnosed tuberculosis at a designated tuberculosis clinic than at a university hospital in inner-city Chicago during their 3-year training.