Health management of tuberculosis patients
I. service objects
Tuberculosis patients diagnosed in the district.
II. Service content
(I) screening and referral
For residents or patients who come to see a doctor within the jurisdiction, if they find chronic cough, sputum cough ≥2 weeks, hemoptysis, blood sputum, fever, night sweat, chest pain or unexplained wasting and other suspicious symptoms of tuberculosis, fill in the "two-way referral form" on the basis of differential diagnosis. It is recommended to TB designated medical institutions for TB testing. The patients were followed up by telephone within 1 week to see if they went to see a doctor and urge them to seek medical treatment in time.
(2) the first household follow-up
After receiving the notification of management of tuberculosis patients from the superior professional institution, the patients shall be visited within 72 hours. The specific contents are as follows: If family members are selected, family members must be trained. Determine the location and duration of medication with the patient. According to the chemotherapy plan, inform the supervisor of the filling method of "tuberculosis patient treatment record card" or "multi-drug resistant tuberculosis patient medication card" and the time and place of taking the medicine, and remind the patient to take the medicine on time and return to the doctor.
(2) assess the living environment of the patients and tell the patients and their families to do a good job in protection to prevent infection.
(3) carry out publicity and education on tuberculosis prevention and control knowledge to patients and their families.
(4) tell patients to seek medical treatment in time when they have serious illness, serious adverse reactions, complications and other abnormal conditions.
If no patient is seen in 2 visits within 72 hours, the results of visits will be reported to the superior professional institution.
(3) supervise the administration of medication and follow-up
1. Supervise taking medicine
(1) medical staff supervision: on the day when patients take medicine, medical staff shall supervise patients to take medicine under direct visual inspection.
(2) supervision of family members: patients should take the medicine in front of family members each time.
2. Follow-up evaluation
For patients supervised by medical staff, follow-up evaluation results of patients should be recorded by medical staff at least once a month. For patients supervised by family members, primary medical and health institutions should follow up the patients every 10 days during the intensive period or the injection period, and follow up every 1 month during the continuation period or the non-injection period.
(1) assess whether there is any critical situation, if there is, make emergency referral, and actively follow up the referral within 2 weeks.
(2) for patients who do not need urgent referral, understand the patient's medication status (including whether the medication is regular and whether there are adverse reactions), and ask about the symptoms from the last follow-up to the current follow-up. Ask about other medical conditions, medication history, and lifestyle.
3. Classified intervention
(1) for patients who can take the medicine on time and have no adverse reactions, continue to supervise the taking of the medicine and make an appointment for the next follow-up.
(2) if the patient fails to take the medicine as prescribed by the doctor in the designated medical institution, the reason should be ascertained. If the adverse reactions caused, then referral; If other reasons, it is necessary to strengthen health education to patients. If patients miss medication more than 1 week or more, they should report to the higher professional institutions in time.
(3) patients with adverse drug reactions, complications or complications should be transferred immediately and followed up within 2 weeks.
(4) remind and urge patients to go to designated medical institutions on time for follow-up consultation.
(IV) case closing evaluation
When the patient stopped anti-tuberculosis treatment, the case should be evaluated, including: recording the time and reason of the patient stopped treatment; To evaluate the management of the whole course of medication; Collect and report the "tuberculosis patient treatment record card" or "mdr-tb patient medication card". At the same time, the patient was referred to a designated TB medical institution for treatment outcome evaluation, and telephone follow-up was conducted within 2 weeks to see whether the patient had gone for treatment and the diagnosis result.