Download 12 week Latent Tuberculosis Infection Treatment

NURSE MANAGED
12 WEEK LATENT TUBERCULOSIS
INFECTION TREATMENT
CONTRA COSTA COUNTY
HEALTH CARE FOR HOMELESS
Jo Elliff, FNP
Rose Vigil, RN
HCH MISSION STATEMENT
Our mission is to reach out and serve
homeless adults, children and families of
Contra Costa County by providing
accessible, culturally sensitive services in
order to promote wellness, prevent
illness and to provide care when
needed so that ultimately, we may
improve the health status of this
vulnerable population.
WHO QUALIFIES AS HOMELESS?
• Lacking a fixed, regular,
adequate nighttime residence
• Primary night-time residence in a
shelter, welfare hotel, transitional
housing or street
• “Doubled-up” without name on
a lease, couch surfing, etc.
FUNDING FOR HCH SERVICES
Section 330(h) Public
Health Services Act Health
Care for the Homeless
grant from the Federal
Government
(Health Resources and Services Administration, HRSA)
HCH TYPES OF SERVICES
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HCH Ambulatory Clinics
HCH Mobile Clinics
Respite Care
HCH Behavioral Health Services
HCH Dental Clinics
Medical Outreach Team
Eligibility Services
Linkages to Care (Specialty services, establishing a
medical home, PCP)
HCH TEAM
• Medical Director
• Program Manager
• Family Nurse
Practitioners (FNP)
• Registered Nurses (RN)
• Community Health
Workers (CHW)
• Certified Enrollment
Counselors
Consumer Liaison
• Consumer Liaison
• Senior Health Education
Specialist
• Mental Health
Specialist
• Licensed Clinical Social
Worker (LCSW)
• Dentist
• Registered Dental
Assistant
HOMELESS POPULATION SERVED
The number of homeless patients served by Contra
Costa Health Services in 2015
31, 093
Unduplicated Homeless Patients
• Medical Visits: 100,532
• Dental Visits:4,058
• Mental Health Visits: 33,321
• Substance Abuse Visits: 11,623
PATIENTS COMPLETED TREATMENT
WHO GETS TESTED?
•Entry into shelters
•Entry into rehabilitation
centers
•Foreign born
•General health screen
TESTING PROCESS
• Health Screen
• Initial testing
• TST (Tuberculosis Skin Test)
• QFT (Quantiferon)
• If initial screening is positive:
•  chest x-ray
•  if chest x-ray negative and patient is
asymptomatic = consider LTBI treatment
RESULT FOLLOW UP
• Discuss diagnosis
• Discuss treatment options
• Discuss the risks/benefits of treatments
• Physical evaluation
• Importance of medication adherence
• Asses adherence to treatment plan
• Provider order medications
• Schedule follow up with RN for 12 week
nurse managed LTBI treatment
NURSE MANAGED LTBI TREATMENT
DIRECTLY OBSERVED TREATMENT
• Starting Treatment
• Discuss possible side-effects to treatment
resistance
• Weekly symptom screen
• Positive symptom screen follow protocol
• Reinforce importance of medication
adherence
• Identify potential barrier to adherence
• Establish plan to ensure adherence
CHALLENGES OF MEDICATION
ADHERENCE
• Lack of access to health care
• Co-existing medical conditions
• Unstable housing
• Require weekly visits
• Low health literacy
• Alcohol/substance use
• High number of life stressors
• Language barrier
WHY IT WORKS
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Initial testing to follow up  1 week
Shorter duration of treatment
Extended shelter stay
Part of comprehensive care
Mobile
Provide transportation vouchers (i.e. bus tickets)
No cost medication
Medications kept centralized
Spanish speaking providers
Core Outreach team
PHN referral
ON GOING CHALLENGES
• Lost to care – jail
• Lost to follow up – moved out of
area
• Hospitalizations
• Non – compliance
• Transportation