Ending Neglect The Elimination of Tuberculosis in the United States (2000) / Chapter Skim
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Appendix C Site Visit Summaries
Appendix C Site Visit Summaries
Pages 182-204
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From page 182... ...
There were additional presentations on the Public Health Prevention Service and TB laboratory activities. Field Services Branch The Field Services Branch provides medical and programmatic consultation to State and local health departments in tuberculosis control activities and is a focal point linking the CDC with TB controllers.
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The branch has 48 field staff positions assigned to State and local tuberculosis programs. Currently there are 33 public health advisors and 5 medical officers assigned and 12 vacancies.
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The laboratory also provides consultation in the evaluation of new laboratory technology for operational use. The site visit on fuly 20 continued with a review of the tuberculosis program in Atlanta and the State of Georgia by Don Hopkins and the IOM staff.
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WASHINGTON, D.C., SITE VISIT SEPTEMBER 29, 1999 On September 29, 1999, Philip Hopewell, Patrick Chaulk, and Fran DuMelle represented the IOM's Committee on Tuberculosis Elimination, and IOM staffer, Donna Almario, visited D.C.'s Tuberculosis Clinic located on the grounds of D.C. General Hospital.
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From page 186... ...
Participants at the site visit commented that it would be beneficial to have a full service TB laboratory in the District, especially given that ten hospitals and several medical schools are in the area. Tuberculosis specimens were previously sent to a Virginia laboratory, but D.C.
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On average, each outreach worker supervises eight patients and visits each patient three times a week. In addition to administering DOT, each outreach worker conducts case investigations, screening, educational activities, TB skin testing, contact investigations, and brings positive skin tester in for X-rays.
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From page 188... ...
MASSACHUSETTS SITE VISIT AUGUST 16, 1999 On August 16, 1999, Ronald Bayer, Sue Etkind, and Morton Swartz from the IOM Committee, along with Lawrence Geiter and Donna Almario, IOM staff, visited Boston, Massachusetts to learn from the TB control programs on both the city and state level. Boston Tuberculosis Control Program John Bernardo, Denise O'Connor, and Claire Murphy presented an overview of Boston's Tuberculosis Control Program.
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The public health nurse collaborates with the primary physician, follows patients from diagnosis to discharge, continually assesses the clinical response and treatment adherence, conducts contact investigation, and medical evaluation of contacts. · Coordinator of Care.
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Community Based Approach Towards Prevention Along with the case management model, the tuberculosis program utilizes a community-based approach toward TB prevention. This includes collaboration with neighborhood health centers and education of providers at neighborhood health centers.
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The hospital is funded by the Department of Public Health and has a collaborative relationship with the TB Division. SAN DIEGO SITE VISIT AUGUST 2-3, 1999 Peter Small and Lester Wright, members of the committee, and Larry Geiter and Donna Almario, IOM staff, visited with staff of the San Diego County Tuberculosis Program in California on August 2-3, 1999 and also visited tuberculosis control facilities in Tijuana, Mexico on August 3.
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From page 192... ...
It was suggested that there should be a national standardized training and certification process for civil surgeons regarding tuberculosis. Housing Programs The committee visited The Bissell House, a state funded housing sponsored by the San Diego County Tuberculosis Control Program and the American Lung Association of the San Diego and Imperial Counties.
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The California Department of Health Services developed the MCTB program to provide a new funding source for TB programs to cover costs that would otherwise be borne by local communities. For persons who qualify for the TB benefit, the program covers outpatient TB services including directly observed therapy (DOT)
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MCTB revenues are paying for the financial counselors and have helped the TB program up-grade several positions. Relationship with Mexico With its close proximity to the Mexican border, the San Diego County Health Department has several programs dealing with border issues.
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From page 195... ...
Operated by the San Diego County TB Control Program and funded by the State of California Department of Health Services, the Centers for Disease Control and Prevention, and private funds, CURE TB also provides assistance directly to TB patients via a toll free 1-800 number accessible from both countries. CURE TB works closely with the Mexican Ministry of Health and other U.S.
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From page 196... ...
Patrick Chaulk, David Fleming, and John Sbarbaro represented the committee; staffers Lawrence Geiter and Donna Almario also attended. The site visit included an overview of the care provided for tuberculosis cases in Seattle-King County's TB program at Harborview Medical Center, including the DOT program, contact program, and programs targeted towards the foreign born.
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From page 197... ...
The patient's outreach worker commented that in terms of ensuring therapy completion and adherence there needs to be more incentives, more case management, more referrals to social services, obtaining results sooner, decreasing the size of pills, and better culture-appropriate educational material for both the patient and outreach worker.
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From page 198... ...
There is, though, a need for more outreach workers and testing of targeted populations, including injection drug-users. Diverse Populations Since 67% of the tuberculosis cases are foreign born, many of the TB prevention programs in Seattle-King County have focused on the immigrant and refugee population.
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In 1996, TacomaPierce County Health Department reorganized their health department. This restructuring included privatizing the tuberculosis control program through a contract with an infectious disease specialty group called Infections Limited.
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and white. Funding for Tacoma-Pierce County Health Department Tuberculosis program is $821,480 with 12% from state funds and 88% from Pierce County Special.
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BSN, Director, Tuberculosis Control Program; Ellen Bridge, Consultant, Public Health Nursing; Kathleen Gensheimer, M.D., M.P.H., TB Program Medical Director; Paul Kuehnert, M.S., R.N., Director Division of Disease Control; Beth Patterson, Consultant, Public Health Nursing; Valerie Ricker, R.N., Community and Family Health; Steve Shapiro, Tuberculosis Control Program; Kim Ware, R.N., BSN, Public Health Nursing, Augusta. The primary objective of this meeting was to get an overview of tuberculosis services in the State of Maine.
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From page 202... ...
This type of training will be vital to support an expanded program of targeted testing and treatment of latent infection. The second meeting was at the Health and Environmental Testing Laboratory, with the following in attendance: Osborne Coates, M.D., Chair Tuberculosis Program Consultants; Steve Shapiro, Tuberculosis Control Program; fulie Crosby, Health and Environmental Testing Laboratory; loan Blossom, R.N., B.S.N., Director, Tuberculosis Control Program; Kathleen Gensheimer, M.D., M.P.H.
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From page 203... ...
In general, the greatest need seemed to be to identify new strategies to deal with preventive therapy. Before leaving Augusta, the site visit team had the opportunity to attend a portion of a meeting with the state society of the Association of Practitioners of Infection Control (APIC)
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From page 204... ...
About 50% of the refugees are tuberculin skin-test positive but completion of therapy rates is difficult and public health nurses make frequent home visits. Again, the problem of maintaining adherence with treatment for latent infection was a major concern.
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