PattiDOTS, DOTSy Lenny, DOTSper UPCM 2016A: XVI, Walang Kapantay! 1 of 1

OS 213: Human Disease and Treatment 3 (Circulation and Respiration) LEC 09: TB DOTS

Exam 3 | Grace Rondillo, RN | 04 February 2013

OUTLINE

I. UP PRIME TB DOTS A. General Data B. History C. Current Epidemiology D. System of Care

II. Forms Used A. Intra-Hospital TB Referral Form B. NTP Referral from Hospitals Form C. MDR-TB Suspects Referral Form

III. TB in the Philippines A. Association with Co-Morbids B. Rise in MDR-TB C. Stigma Still Present

Speaker is Nurse Grace Rondillo, head nurse of OPD Small Clinics (such as allergy, TB DOTS, Drug Test, etc.)

UP PRIME TB DOTS General Data

PRIME TB DOTS - PGH Responsive Integrated Multi-Disciplinary Enhanced TB DOTS (Tuberculosis Directly Observed Treatment, Short-course); coined by Dr. Berba

TB DOTS is tutok gamutan, free medicine for TB

Head nurse is Grace Rondillo

Location is near ER/OPS (to avoid spreading of the disease)

History

Only started to have a clinic for TB DOTS in 2010 o PGH director isnt fond of it (TB DOTS), kasi pang health center

lang daw iyun, pero tertiary center daw ang PGH o But more and more complicated cases of secondary TB is found in

the hospital; many times operations are performed on TB patients when the TB meds would suffice

o were gearing towards becoming a TB DOTS providing hospital, instead of just a referring hospital

o But having problem for that goal now because mag-isa lang si Maam Grace

o Staff needed

Dr. Roa is the head of the TB Clinic

WHO Invovlement o Funding, drugs, salary provided by the WHO o WHO still considers the Philippines as a TB burdened country o WHO closely monitoring the TB situation in the country

Current Epidemiology

Philippines 3rd

most burdened TB country, (1st

is India, 2nd

is China)

Rise in the cases of extrapulmonary TB in hospitals o Potts Disease (spinal TB), TB arthritis, TB meningitis, TB adenitis.. o takes longer to treat (1 year) o before TB mostly seen in health centers, now many cases in

hospitals o many afraid to go to the health center because of stigma, rather

go to hospital for treatment o many new cases of medical students, residents (especially in Dept

of Medicine, Dept of Neuro from performing intubation without masks)

o many having TB as a co-morbid to their chief complaint as a secondary infection

System of Care

Requires positive AFB smears and X-ray For Sputum Positive Patients

Needs at least 2 out of 3 positive AFB smears o minimum of three smears performed o gold standard

For Sputum Negative Patients

Assessed by TB-DC: TB Diagnostic Committee o To treat or not to treat, they are the ones who decide o Consists of 1 pulmo IDS consultant, 1 radiologist & 1 manila

health department representative o they will rely on X-ray/radiologic findings o if its not TB and they treat, will do more harm than good

FORMS USED

Intra-Hospital TB Referral Form (Green Form)

used to be color blue but changed to green (blue is the color of death certificate)

used for patients coming from the Wards or OPD

First page contains general data of hospital case, referring physician, patient information, patient history, diagnostic exam resuts and diagnosis of referring service (to be filled out by the attending physician)

Second page is a return-slip (to be filled out by pulmo IDS fellow) with patient information, referring unit information, recommended actions (type of treatment, single drug treatment options for patient with liver/kidney problems, referral to TBDC if applicable or referral to DOTS facility)

NTP Referral from Hospitals Form (Yellow Form)

used to specifically refer patients to health centers

includes info of referring hospital, patient information, reason for referral, classification of patient (pulmonary, extrapulmonary), type of patient (new, failure, RAD, relapse, transfer in, other), category of treatment [category I, II, III, IV (MDR-TB)]

has a return-slip at the bottom to be filled up by receiving DOTS facility/health center to let the referring hospital know that the patient was accommodated

MDR-TB Suspects Referral Form (White Form)

used for referring patients suspected to have MDR-TB to Treatment Hubs (since PGH not a providing hospital yet)

contains patient information, referring health facility, referred treatment hub information, reasons for referring MDR-TB suspect, and TB history & treatment of patient

Treatment Hubs: Quezon Institute, Lung Center of the Philippines, Tala in Caloocan, La Salle Treatment Hub in Cavite (has costs but minimal)

TB IN THE PHILIPPINES

Association Co-Morbids

HIV

PGH is already a treatment hub for HIV

high prevalence of TB in HIV patients already proven

Diabetes

Studies on-going on association with Diabetes

Observations of close association at the moment

Rise in MDR-TB

MDR-TB

TB can ordinarily can infect 5 persons in one sneeze, but in MDR-TB even the whole room

more contagious, must wear protective masks (N95)

problem of doctors diagnosing numerous presentations as TB right away, patients also self-medicating or not undergoing full treatment

Stigma Still Present

Stigma preventing many patients from going to the health center for treatment (tsismis ng mga ka-barangay)

Quezon Institute: Some patients, even if well already, still dont want to go home because of the family maintaining the stigma against them. Some are transferred to Lung Center just so they dont have to go home, but theres cost involved there

Government making effort to address the stigma by saying that TB is treatable, that medicines are available

OS 213 LEC 09: TB DOTS

Patti, Leonard, Jasper UPCM 2016A: XVI, Walang Kapantay! 2 of 1

Maams concerns: Dont get sick, youd be out for months. Technically, if youve been taking the meds for 2 weeks you are non-contagious, but negative sputum tests necessary to go back to school.

END OF TRANSCRIPTION Patti: Hello 2016! Good Luck sa exams andAdvanced Happy Valentines sa inyong lahat ^_^

Leonard: Shout out to the cool kids of the 2

nd row of the east! =)

Jasper:

God bless everyone on the exam!=)