7/27/2012 1 TB Nurse Case Management San Antonio, Texas July 18 – 20, 2012 Working with Private Providers and the New Federally Qualified Health Centers Linda Dooley, MD July 20, 2012 Linda Dooley, MD has the following disclosures to make: • No conflict of interests • No relevant financial relationships with any commercial companies pertaining to this educational activity
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TB Nurse Case ManagementSan Antonio, TexasJuly 18 – 20, 2012
Working with Private Providers and the New Federally Qualified
Health CentersLinda Dooley, MD
July 20, 2012
Linda Dooley, MD has the following disclosures to make:
• No conflict of interests
• No relevant financial relationships with any commercial companies pertaining to this educational activity
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Public Private Roles in TB
Linda Dooley, MD
Austin-Travis County HHSD
Austin, Texas Joint city/county health department Population 1,024,266 (county 2010)
Had 68 TB cases in 2010; 52 in 2011
35 suspects not TB in 2011: about 1/3 got TB meds by DOT
Latent TB: 768 started on INH last year; usually about 4000 patient on INH at one time
Communicable Disease Unit TB/ STD/ HIV
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TB Clinic in Austin
One MD position (shared) 3 RN nurse case managers 1 LVN latent TB case manager 2 contact investigators 4 outreach workers for DOT X-ray tech for on-site x-rays Sputum booth for induced sputum
Private doctors always have some requirements always in place
What is Public Health always responsible for? We are the agency to whom reporting is
done
TB reporting is required within a single working day Texas Health and Safety Code, Chapters 81
and 89
Texas Administrative Code, Title 25, Part 1, Chapter 97
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More Public Health Roles
DOT
Quarantine when necessary
Contact investigation
AUSTIN HEALTH AND HUMAN SERVICES DEPARTMENTTRAVIS COUNTY HEALTH DEPARTMENT
TUBERCULOSIS ELIMINATION PROGRAMORDER TO IMPLEMENT AND CARRY OUT MEASURES
FOR A CLIENT WITH SUSPECTED OR CONFIRMED TUBERCULOSIS
I have reasonable cause to believe that your diagnosis, based on information available at this time, is (probably/definitely)
TUBERCULOSIS (TB), which is a serious communicable disease. Adequate Directly Observed Therapy (see below) is usually very
effective in curing an individual with TB and may quickly decrease the likelihood of TB being spread to others. Therefore, by the
authority given to me by the Texas Health and Safety Code, Chapter 81, I hereby order the following control measures:
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1. Follow all orders regarding your treatment given to you by the physicians of the Tuberculosis Elimination Program (TBEP). Keep all clinic appointments ordered by the TBEP clinic staff. Several appointments will be necessary to be sure your treatment is working. The treatment for tuberculosis is usually for six or more months. It is very important for you to keep all of the appointments made for you. __________________
(client’s initials/date)2. Come to the TBEP clinic or be at an agreed place at agreed times for
Directly Observed Therapy (DOT). Taking DOT means that a health care worker will meet you at a scheduled time and place and observe you take your medication as ordered by the doctor. This ensures that you will receive the treatment necessary to fully cure your tuberculosis. __________________
(client’s initials/date)
3. Report changes in your health to TBEP staff. Provide sputum, urine and blood specimens as ordered by the clinic physician. _________________
(client’s initials/date)
4. Provide identifying information to TBEP staff regarding those individuals with whom you have contact at your home, your job and through other activities.
__________________(client’s initials/date)
5. Since you are capable of spreading TB to others, you must stay in your home except as authorized by your clinic physician. Do not return to work or school until authorized. Do no allow anyone other than those already living with you or health department staff into your home until authorized to do so.
_______ (Initials and date)
6. Report any temporary or permanent changes in address to health department staff.
________ (initials and date)
7. Special orders___________________________________________________________
________(initials and date)
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Examples of “Special Orders” Abstain from alcohol since it interferes
with your treatment.
Meet your outreach worker within 15 minutes of scheduled time.
Do not go to church or teach Sunday School until cleared to do so.
Do not curse at TB staff.
Give the warning letter at the first visit
to all your cases/suspects.
Never wait until you have a problem to tell the patient what
he should have been doing.
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New warning Letters may be given at any time during treatment to reinforce previous health authority orders or add new orders
What does Public Health usually do? Toxicity monitoring LFT’s, CBCs
Eye exams
Case management Work issues, FEMLA, disability, dealing with
employers
Referrals for food or temporary shelter
Referrals for medical care for other problems
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What is the private doctor always responsible for?
Thinking of TB as a possible diagnosis
Reporting, including suspected TB, within ONE working day
Taking care of the patient until the Health Department takes over
What does the private doctor sometimes do? evaluation of the patient
CXR interpretation
prescribe TB medications
monitor and manage treatment and toxicity
manage co-morbid conditions
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Federally Qualified Health Centers Not new but expanded under Health Center
Consolidation Act and increased funding under Affordable Care Act ($11 billion)
Community-based; comprehensive care including preventive care and substance abuse treatment
Provide care to all regardless of ability to pay (sliding scale fees), age, or legal status
Resources
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Heartland National TB Center
State TB Experts: Dr. Armitige Dr. Connelly-Smith Dr. Griffith Dr. Seaworth
State and regional TB Nurse Consultants
Other National TB training Centers Check Heartland Website under “Products” (top right of opening page) Look also at other TB training centers products at bottom of list (“Joint RTMCC