Analysis of panel physician inquiries to U.S. TB Centers of Excellence, 2018-2022.

IJTLD open Pub Date : 2024-11-01 DOI:10.5588/ijtldopen.24.0056

E Leithead, S Subramanian, K Pimenta, N D Goswami, A Patrawalla, A Lardizabal, C Haley, L Chen, L Armitige, B Seaworth, B Sylvester, R Bhavaraju

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Abstract

Background: Applicants seeking entry into the United States are examined overseas for TB by panel physicians and international immigration clinicians guided by Centers for Disease Control and Prevention (CDC) TB Technical Instructions. To support this effort, CDC-funded TB Centers of Excellence (COEs) provide web-based expert consultation, with documentation stored in a medical consultation database (MCD). MCD analysis can reveal inquiry trends among panel physicians worldwide.

Methods: TB-related queries in the COE MCD from January 1, 2018, to December 31, 2022, were analyzed using a descriptive coding scheme developed through inductive analysis, allowing multiple themes per entry.

Results: A total of 215 queries from 126 patients in 28 countries were analyzed. Major themes included evaluating diagnostic criteria, tailoring treatment, and managing comorbidities or adverse reactions. Diagnostic questions (n = 104, 48.4%) included mycobacterial culture, smear, and radiology interpretation. Treatment tailoring inquiries involved optimizing the initial regimen (n = 89, 41.4%) or modifying existing regimens (n = 26, 12.1%). Additionally, 50 consultations (23.2%) mentioned comorbidities, while 47 (21.9%) described adverse reactions.

Conclusion: The MCD analysis identified topics where TB expertise was provided in overseas medical evaluation. These topics highlight opportunities for targeted panel physician education to improve the health of individual applicants and advance U.S. TB elimination efforts.

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2018-2022年向美国结核病卓越中心咨询的小组医生分析。

背景：在美国疾病控制和预防中心（CDC）《结核病技术指南》的指导下，由专家小组医生和国际移民临床医生对寻求进入美国的海外申请人进行结核病检查。为支持这项工作，美国疾病预防控制中心（CDC）资助的结核病卓越中心（COEs）提供基于网络的专家咨询，并将文件存储在医疗咨询数据库（MCD）中。MCD 分析可揭示全球专家小组医生的询问趋势：采用归纳分析法制定的描述性编码方案，对2018年1月1日至2022年12月31日期间COE MCD中与结核病相关的查询进行分析，每个条目允许多个主题：共分析了来自 28 个国家 126 名患者的 215 项查询。主要主题包括评估诊断标准、调整治疗方法以及处理合并症或不良反应。诊断问题（n = 104，48.4%）包括霉菌培养、涂片和放射学解释。定制治疗咨询包括优化初始治疗方案（89 人，占 41.4%）或修改现有治疗方案（26 人，占 12.1%）。此外，50 次咨询（23.2%）提到了合并症，47 次咨询（21.9%）描述了不良反应：MCD 分析确定了海外医疗评估中提供结核病专业知识的主题。这些主题凸显了有针对性的小组医生教育机会，以改善申请者个人的健康状况并推动美国消除结核病的工作。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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