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The best way to tell the story of how a clinic is adapting to better serve the needs of its patients is to have one of those very patients attest to how these changes will improve their lives. But when that clinic serves people living with tuberculosis (TB), a sad reality comes to light – stigma about the disease endures.
"Some people don't want to admit that they have TB," says Judith Lang a Nurse Practitioner at Toronto Western Hospital's Tuberculosis Clinic. "Not even to their own families."
Having TB and needing ongoing treatment to manage it is part of the reason staff at the clinic is piloting a change in schedule: for one night a month, the clinic will see patients in the evening between 5 p.m. and 7 p.m. starting April 18.
"Day appointments are often difficult for patients to accommodate," Judith says. "Many of our patients are in jobs where if they don't work, they don't get paid.
"Taking the time off to come to the clinic is a huge burden, some patients may even forgo preventative treatment entirely in order not to miss work."
TB is a contagious disease that can affect any part of the body but most often attacks the lungs. Although more prominent in the early 20th century as more people moved to cities, TB is still one of the top 10 causes of death globally.
According to Toronto Public Health, 10 million people contract TB worldwide every year including 300 cases in Toronto. World Tuberculosis Day is Saturday, March 24.
Not everyone infected with TB gets sick, however, TB germs can live in the body and "reawaken" at any time. Known as Latent TB Infection (LTBI), this dormant form of the illness is not contagious and can be treated with an ongoing antibiotic regimen under the supervision of health practitioners. Treatment is the only way to reduce the chance of the disease becoming active, hence the need for clinic hours more suitable to patients' work schedules.
"We are a specialty clinic and see patients from everywhere in and around the Greater Toronto Area," says Andrea Moore, a nurse clinician with the clinic. "We try to refer patients to local care providers but it's not always available in their community, so travel time is also taken into consideration for these patients when trying to organize their appointments."
Treatment for LTBI involves a daily medication and vitamin for nine months. However, there is a risk of several potential side effects, including liver toxicity, requiring a monthly appointment at the clinic to monitor a patient's blood work and tolerance of the treatment. After three months, if the patient is stable, they can then transition to an appointment every other month for the rest of the treatment.
These follow-up appointments can be quite long as they involve, blood work, a physical, and meeting with specialists – all of which add up time-wise.
"This really was an opportunity for us to rethink how we currently deliver care and see what changes we could make to better meet our patients' needs," Andrea says. "This option will really help reduce anxiety among our patients about having to take time off work and many are excited for the clinic to open."
Seeing LTBI patients in the evening will also make room for additional appointments in the day time clinic so the team can see more patients with active TB – the form of the disease that is contagious. This shift has the added benefit of improving the overall referral process to the TB clinic.
The evening clinic will be trialed for six months and, if it proves successful will expand to two evenings per month.