Unwarranted variations and categories of care [7] applied to treatment of latent tuberculosis infection (LTBI)

Category of unwarranted variation applied to LTBI treatmentExample quotes that indicate unwarranted treatment variationUnderlying challenge
Effective care“I often see the situation where a TB contact has been found to have latent TB according to their Mantoux test, and yet the decision is made not to offer treatment because they were born overseas and have possibly already been infected in their home country.”Physicians are prone to cognitive biases like everybody else
 Benefits of LTBI treatment clearly outweigh the risks, e.g. close contact of an infectious TB patient
Preference-sensitive care“A difficult patient is a healthcare worker with a positive skin test. I think that they're the ones that are tricky, because I don't think my management is very consistent with that type of patient.”Physicians try to make decisions for patients in grey areas of risk and benefit, where ideally shared decision making should be used
 Grey area of risk and benefit, decision for or against treatment should be informed by patient choice, e.g. older healthcare worker who has evidence of LTBI
Supply-sensitive care“The immigrants that we follow-up in the clinic who have latent TB are probably undertreated, I think, mainly because of lack of resources in terms of nursing, lack of doctors able to see these patients and the sheer growth of the immigrant population.”There is a lack of resources (infrastructure, human resources, etc.) to provide optimal care
 Frequency of use of the intervention depends on the capacity of the local healthcare system, e.g. LTBI is undertreated because of lack of staff in TB clinics