Provincial Tuberculosis Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada.
Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.
PLoS One. 2023 Sep 21;18(9):e0291997. doi: 10.1371/journal.pone.0291997. eCollection 2023.
Recent data have demonstrated that healthcare use after treatment for respiratory tuberculosis (TB) remains elevated in the years following treatment completion. However, it remains unclear which TB survivors are high healthcare users and whether any variation exists within this population. Thus, the primary objective of this study was to identify distinct profiles of high healthcare-use TB survivors to help inform post-treatment support and care.
Using linked health administrative data from British Columbia, Canada, we identified foreign-born individuals who completed treatment for incident respiratory TB between 1990 and 2019. We defined high healthcare-use TB survivors as those in the top 10% of annual emergency department visits, hospital admissions, or general practitioner visits among the study population during the five-year period immediately following TB treatment completion. We then used latent class analysis to categorize the identified high healthcare-use TB survivors into subgroups.
Of the 1,240 people who completed treatment for respiratory TB, 258 (20.8%) people were identified as high post- TB healthcare users. Latent class analysis results in a 2-class solution. Class 1 (n = 196; 76.0%) included older individuals (median age 71.0; IQR 59.8, 79.0) with a higher probability of pre-existing hypertension and diabetes (41.3% and 33.2%, respectively). Class 2 (n = 62; 24.0%) comprised of younger individuals (median age 31.0; IQR 27.0, 41.0) with a high probability (61.3%) of immigrating to Canada within five years of their TB diagnosis and a low probability (11.3%) of moderate to high continuity of primary care.
Our findings suggest that foreign-born high healthcare-use TB survivors in a high-resource setting may be categorized into distinct profiles to help guide the development of person-centred care strategies targeting the long-term health impacts TB survivors face.
最近的数据表明，在治疗完成后的几年中，接受呼吸道结核病（TB）治疗的患者的医疗保健使用量仍然很高。然而，目前尚不清楚哪些结核病幸存者是高医疗保健使用者，以及在这一人群中是否存在任何差异。因此，本研究的主要目的是确定高医疗保健使用结核病幸存者的不同特征，以帮助为治疗后提供支持和护理。
我们使用来自加拿大不列颠哥伦比亚省的链接健康管理数据，确定了 1990 年至 2019 年间完成治疗的新发呼吸道结核病的外国出生者。我们将高医疗保健使用结核病幸存者定义为在治疗完成后五年内，研究人群中每年急诊就诊、住院或全科医生就诊中排名前 10%的患者。然后，我们使用潜在类别分析将确定的高医疗保健使用结核病幸存者分为亚组。
在完成呼吸道结核病治疗的 1240 人中，有 258 人（20.8%）被确定为结核病后高医疗保健使用者。潜在类别分析结果为 2 类解决方案。第 1 类（n = 196；76.0%）包括年龄较大的个体（中位数年龄 71.0；IQR 59.8，79.0），他们更有可能患有高血压和糖尿病（分别为 41.3%和 33.2%）。第 2 类（n = 62；24.0%）包括年龄较小的个体（中位数年龄 31.0；IQR 27.0，41.0），他们更有可能在结核病诊断后的五年内移民到加拿大，并且中等至高度的初级保健连续性的可能性较低（11.3%）。
我们的研究结果表明，在高资源环境下，外国出生的高医疗保健使用结核病幸存者可能分为不同的特征，以帮助指导针对结核病幸存者面临的长期健康影响制定以患者为中心的护理策略。
