Open Collections

Romanowski, Kamila

University of British Columbia

Among people who survive tuberculosis disease, there are individuals who may benefit from integrated care strategies aimed at mitigating post-tuberculosis morbidity. However, we need a clearer understanding of which individuals will require or seek out significant healthcare post-tuberculosis treatment and what care strategies can be implemented. Thus, for this dissertation, we sought to (1) measure healthcare use post-tuberculosis treatment among foreign-born individuals treated for tuberculosis in British Columbia, Canada; (2) identify distinct profiles of high-healthcare use foreign-born tuberculosis survivors in British Columbia, Canada; (3) review interventions addressing common non-communicable diseases that commonly affect people with tuberculosis; and (4) explore healthcare providers' perceptions of post-tuberculosis care in British Columbia, Canada, define the core components of post-tuberculosis management, and identify facilitators and enablers to their successful implementation. Using an interrupted time series analysis, we found foreign-born tuberculosis survivors in British Columbia experienced an excess 12.2 (95% CI 10.6, 14.9) outpatient visits and 0.4 (95% CI 0.3, 0.5) hospitalizations in the five years following completion of tuberculosis therapy. Applying latent class analysis, we categorized foreign-born high-healthcare use tuberculosis survivors in British Columbia into two distinct profiles: older individuals with pre-existing comorbidities and younger recent migrants with low continuity of primary care. Our scoping review identified the most common non-communicable disease interventions among people who have experienced tuberculosis, including referral for diabetes care, pulmonary rehabilitation programs, care programs for alcohol use disorder, and psychosocial support or individual counselling. Yet, a significant knowledge gap remains on the long-term effectiveness of these interventions. Lastly, healthcare providers specializing in tuberculosis care in British Columbia acknowledge that post-tuberculosis care is integral to comprehensive healthcare. They believe it should include a few targeted measures, including routinely linking people with tuberculosis to a primary care provider if they do not have one. However, a lack of time and resources influences their ability to initiate and provide post-tuberculosis care. Care navigation services, a post-tuberculosis checklist, and information leaflets may help resolve some barriers. Overall, our findings underscore the need for coordinated, continuous, and high-quality care among people with tuberculosis to reduce resource use and enhance health outcomes along the care continuum.

Text

2023-12-01

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/86725

Experimental Medicine

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/