Innovations in outpatient care for people with tuberculosis

Ukraine has introduced a number of changes that allow system to quickly reform approaches to providing quality services to people with tuberculosis and to establish control over the disease.

These changes include the development of an outpatient care system for people with tuberculosis, in compliance with modern principles of infection control, social support for patients, introduction and expansion of innovative methods of diagnosis and treatment.

Outpatient care for people with tuberculosis is provided as part of the program of medical guarantees for the provision of the following guaranteed packages of services:

• support and treatment of adults and children with tuberculosis at the primary level of medical care;
• diagnosis and treatment of adults and children with tuberculosis in outpatient and inpatient settings, implemented by regional tuberculosis centers.

We are all aware that the treatment of tuberculosis, especially drug-resistant forms, is a great challenge for the patient and his family. Therefore, comprehensive care, treatment and prevention are very important.

The provision of services to people with tuberculosis should be based on a patient-centered approach, as a fundamental principle of a quality health care system based on the following principles: 

• respect for the values ​​and beliefs of the patient - involvement of patients in clinical decisions, recognition of their right to their own beliefs, needs, privacy, dignity, non-discrimination;
• coordination and integration of care - efficient use of resources through coordination of care and cooperation with narrow specialists, protection of the patient's interests;
• information, communication, training - information about the clinical condition, progress and prognosis, about the processes of treatment / care, information needed to increase patient independence, self-help and health;
• physical comfort, pain reduction - the level of physical comfort for patients is of great importance. The most important for patients are three aspects: pain management; assistance in daily activities and provision of daily living needs; medical institution and its atmosphere;
• emotional support, reducing fear - the fear and anxiety associated with illness can be as debilitating as the physical consequences. Therefore, health professionals should pay special attention to the patient's anxiety about their own physical condition, treatment and prognosis, the impact of the disease on the family, the patient's concern about the financial consequences of the disease. You should try to support the patient and reduce his anxiety;
• involvement of family and friends - the doctor should take into account the patient's need to involve relatives in making treatment decisions. Without the involvement of the family, it is also impossible to organize the provision of quality medical care to patients with chronic diseases that are often associated with lifestyle;
• continuity of care - Patients are concerned when they have to switch between different units or care facilities. That is why the family doctor can best perform the function of the patient's case manager - to collect and organize all relevant medical information and provide colleagues with clear, complete information about existing diseases, drugs, allergies, physical limitations, dietary needs of the patient and more. It is necessary to coordinate the current treatment and provision of additional services to the patient after discharge. Provide information to the patient on an ongoing basis regarding access to clinical, social, physical and financial support;
• timely and barrier-free access - It is important for patients to know that they will be able to access care when needed. Therefore, care should be taken to provide the patient with information on unimpeded access to the location of dispensaries and hospitals, the availability of public transport, ease of planning visits, appointments, availability of referrals to specialists or specialized services.

The basis for the provision of outpatient services for people with tuberculosis in primary care facilities is the lack of bacterial excretion during bacterioscopic examination of the patient's sputum smear.

The TB doctor refers the patient together with the relevant medical documentation to the doctor with whom the patient signed the declaration. From this time, dynamic monitoring of the health of the patient diagnosed with tuberculosis in the outpatient phase begins. This includes a set of diagnostic and treatment interventions that are required by industry standards in the field of health care. First of all, we are talking about:

• daily control over the intake of anti-TB drugs (including weekends and holidays);
• daily survey for the presence of adverse reactions;
• control of the patient's consultation with a phthisiologist, microbiological, clinical-laboratory and instrumental research in the treatment process in accordance with the calendar of treatment monitoring and indications.

It is important to note that the family doctor is not alone with the patient, but uses a team approach to providing care for each patient - a so-called multidisciplinary team, which includes at least three people from among the following employees:

• primary care physician;
• phthisiologist;
• nurse;
• DOT / VOT curator;
• psychologist;
• representative of civil society institutions.

The main member of the team is a TB doctor, who controls and coordinates the provision of services to all other team members in the process of managing a particular patient. Infectious disease physicians are also involved in teamwork to jointly manage TB / HIV cases. CSOs provide medical and psychosocial support within the framework of grants from international organizations.

During the provision of services, the family doctor and the team form a strong commitment to the patient's treatment by bringing the service closer to the patient, maintaining motivation for treatment with food, hygiene kits, diagnostic services, medications to reduce side effects, travel to the TB doctor. , assistance in solving social problems, legal and psychological assistance, overcoming stigma and discrimination. All of this is provided through a grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria. Measures are also being taken to return patients who have stopped treatment.

Information and outreach work is carried out with patients aimed at developing skills in tuberculosis prevention and reducing the likelihood of transmitting Mycobacterium tuberculosis to others.