The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #58733

Prathibha Varkey, MD, MPH¹, Timothy Aksamit, MD², Michael Schryver³, Larry Edmonson, MPH⁴, Mary Wellik, BSN, MPH⁴, and Michael Brennan, MD³. (1) Division of Preventive and Occupational Medicine, Mayo Clinic, 200 First Street SW, Baldwin 5A, Rochester, MN 55905, (507) 284-3195, varkey.prathibha@mayo.edu, (2) Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 1st st SW, Rochester, MN 55905, (3) Department of Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, (4) Division of Disease Prevention and Control, Olmsted County Public Health Services, 2100 Campus Drive SE, Rochester, MN 55904

Background: Between 1996 and 1999, the incidence of active tuberculosis (TB) in Olmsted County increased by 365 % (from 3.4 per 100,000 to 15.8 per 100, 000). By 2000, 91% of active TB patients were foreign-born, many of who were refugees. Concerns about early detection and treatment, disease transmission, fragmented care delivery, poor compliance, and high hospitalization rates led to collaboration between a major academic medical center and the county public health department. This led to the establishment of the TB clinic in early 2001.

Key elements of the model: The TB Clinic is located within the public health department and has capabilities to diagnose and initiate treatment in the first visit. It is run by a multidisciplinary team supervised by a pulmonologist. It has a state of the art laboratory and digital chest radiography that allows transfer of images for diagnosis by a radiologist within the hour. Case management, direct-observed-therapy, centralized interpreter services and culturally sensitive outreach are other key elements of this model.

Discussion: Since its establishment, 27 patients have been diagnosed with active TB, and 500 with latent TB. Successful completion of therapy has increased from 62% in 1997 to 72% in 2001 for latent TB, and has remained close to 100% for active TB. Centralized case management, proactive early diagnosis and treatment of active and latent TB, direct observed therapy, and improved therapy completion rates have enhanced the cost-effectiveness and efficiency in the management of this significant public health problem. This model lends itself to replication.

Learning Objectives:

At the end of this session, the participant will be able to:
• Articulate five strategies for successful medicine/public health partnerships 2)Define the key components required for a successful tuberculosis clinic catering to a high risk population 3)Construct a successful business model for an innovative public health venture

Keywords: TB, Models for Provision

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: 1)Mayo Clinic, Rochester, MN 2)Olmsted County Public Health Department, MN
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: a) Employed by Mayo Clinic, Rochester, MN b) Consulting physician to Olmsted County Public Health Department, MN