Telehealth Reduces Missed Appointments in Pediatric Patients with Tuberculosis Infection

Angela Zhao,Thomas Murray,Richard Feinn,Nirali Butala,Casey Luc

doi:10.3390/tropicalmed7020026

Angela Zhao, Thomas Murray + Show 3 more

Open Access

https://doi.org/10.3390/tropicalmed7020026

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Abstract

Pediatric patients with untreated tuberculosis infection (TBI), also called latent TBI, are at risk of progression to active TB disease. The primary aim of this study was to identify factors associated with higher rates of missed appointments and failure to complete therapy for pediatric patients with TBI. A secondary aim was to determine the impact of the COVID-19 pandemic and the rise of telehealth on TBI missed appointment rates. We first performed a retrospective chart review of 129 pediatric patients referred to the free Yale Pediatric Winchester Chest Tuberculosis Clinic from 2016–2019. Associations between demographic/clinical variables and missed appointments/failure to complete therapy were analyzed using univariate and bivariate chi-square tests. Language, lack of primary provider, and distance to clinic were the main contributors to missed appointments and poor treatment adherence. There was an association between the number of missed appointments and failure to complete treatment (p = 0.050). A second cohort of 29 patients was analyzed from January–December 2021 when telehealth was offered for follow-up appointments. Of these follow-up visits, 54% were conducted via telehealth, and the clinic’s missed appointment rate dropped significantly from 16.9% to 5.8% during this time frame (p = 0.037). These data demonstrate that telehealth is accepted as an alternative by patients for follow-up TBI visits.

Highlights

One-fourth of the global population is infected with tuberculosis (TB) [1]
TB infection (TBI) or latent TB is defined by an immune response against Mycobacterium tuberculosis in individuals without clinical or microbial evidence of active TB disease
Treatment duration has been identified as a factor associated with treatment completion; studies have shown that TBI patients were more likely to complete treatment using a 4-month regimen of daily rifampin (4R) compared with a 9-month isoniazid regimen (9H) [9,10]

Summary

Introduction

One-fourth of the global population is infected with tuberculosis (TB) [1]. TB infection (TBI) or latent TB is defined by an immune response against Mycobacterium tuberculosis in individuals without clinical or microbial evidence of active TB disease. While most healthy individuals with TBI never develop active TB, 5–15% progress to active disease after a variable period of latency, with the highest risk within 2 years of initial infection [2]. Younger children have a higher risk for progression to active disease compared with the general population, highlighting the importance of treating children with TBI [3,4]. Treatment duration has been identified as a factor associated with treatment completion; studies have shown that TBI patients were more likely to complete treatment using a 4-month regimen of daily rifampin (4R) compared with a 9-month isoniazid regimen (9H) [9,10]. Less is known about specific factors associated with missed appointments that lead to failed therapy and the effect of the SARS-CoV-2, COVID-19 pandemic on the delivery of care for children with TBI

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