Tuberculosis Regional Training and Medical Consultation Centers in the United States: Characteristics, outcomes, and quality of medical consultations, June 1, 2010 - May 31, 2014

Abstract

Background: Tuberculosis (TB) Regional Training and Medical Consultation Centers (RTMCCs) were established in 2005 for TB medical consultation, training and education in the United States. A medical consultation database (MCD) captured all consultations provided by RTMCCs; we report on those provided from June 1, 2010 to May 31, 2014.

Methods: All MCD consultations during 2010-2014 were categorized into: provider type, setting, consultation topic, and patient age. We analyzed data frequencies and performed subgroup analyses by RTMCC, by TB incidence for the geographical area, and by year of consultation. End-user satisfaction was assessed by a 2016 telephone evaluation of RTMCC services.

Results: A total of 11,074 consultations were delivered, with 10,754 (97.1%) in the U.S. and its current or former territories. Of these, 6018 (56%) were for high, 2443 (22.7%) for medium, and 2293 (21.3%) for low TB incidence settings. Most were for adults (81.3%) and answered within 24 h (96.2%). Nearly 2/3 consultations originated from health departments; providers included mostly physicians (44.3%) or nurses (37.6%). Common consult categories included TB disease (47.7%), case management (29.8%), latent TB infection (19.3%), diagnosis (16.1%), pharmacology (14.7%) and adverse side effects (14.3%). Among adverse side effects, hepatotoxicity was most common (39.6%). Volume and nature of consult requests remained relatively stable over the four-year period. Feedback from a 2016 CDC evaluation indicated overall satisfaction with RTMCC medical consultation services.

Conclusion: RTMCCS were an important source of TB medical consultation over the time-frame of this assessment and provided quality expert consultation within 24 h. RMTCCs represent a reservoir of TB subject-matter expertise in the United States.

Keywords: Consultation; Database; Tuberculosis.

Fig. 1

Adult versus Pediatric Consultations Stratified by TB incidence Adult versus pediatric consultations stratified by TB incidence of caller's jurisdiction (high > 800 cases per year, medium 100–800 cases per year, or low < 100 cases/year).

Fig. 2

Topic Areas for Consultations (n = 10,754) Topic Areas for consultations (not mutually exclusive) IC- infection control LTBI – latent TB infection TST – tuberculin skin test IGRA – interferon Gamma Release Assay NTM- nontubercular mycobacteria MDR- multidrug-resistant XDR- extensively drug-resistant.

Fig. 3

Topic Areas for consultation stratified by TB Incidence Topic Areas for Consultations (n = 10,754) stratified by TB incidence of caller's jurisdiction (high > 800 cases per year, medium 100–800 cases per year, or low <100 cases/year).

Fig. 4

Adverse side effects reported stratified by TB incidence of caller's jurisdiction Adverse side effects reported stratified by TB incidence of caller's jurisdiction (high > 800 cases per year, medium 100–800 cases per year, or low <100 cases/year).

Fig. 5

Overall Occupational Settings of Callers Occupational setting of health care professionals seeking consultation Health Dept - unspecified.

Fig. 6

Overall Work Discipline of Callers Work discipline of health care professionals seeking consultation.

Fig. 7

Calls stratified by year of service and TB incidence of caller's jurisdiction Number of calls provided per year of service (June 1 – May 31) stratified by TB incidence of caller's jurisdiction (high > 800 cases per year, medium 100–800 cases per year, or low <100 cases/year).

Fig. 8

RTMCC Calls stratified by year Consultations provided by each center stratified by center (MCCT was not funded until 2012) SNTC – Southeastern National TB Center; NJNTC – Global TB Institute; MCCT– Mayo Clinic Center for Tuberculosis; HNTC – Heartland National TB Center; CNTC – Curry International TB Center.

Fig. 9

Topic Areas stratified by RTMCC Consultation topic areas stratified by RTMCC SNTC – Southeastern National TB Center; NJNTC – Global TB Institute; MCCT – Mayo Clinic Center for Tuberculosis; HNTC – Heartland National TB Center; CNTC – Curry International TB Center.

Fig. 10

International call categories (n = 314) Topic areas for International consultations.

Fig. 11

International calls and adverse side effects (N = 44) Adverse side effects reported among international consultations.

Fig. 12

Time to response from consultant within 24 h – international calls compared with domestic calls Response provided within 24 h among international consultations stratified by Region.