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 Home Minister & Policy
Minister & Policy
 Chung-Hua County Bureau Health Strategies for Implementing DOTS
Strategies origin: Based on Department of Health, The Executive Yuen Disease Control Devision policy: 0950004070 which finalized on March 10th, 2006.
●Background:
Tuberculosis (TB) is still considered to be the most serous infectious disease in Taiwan. In order to effectively prevent the spread of TB, our current prevention policy is: TB “Reduce by half within 10 years” plan. The fundamental idea of the plan is “Targeting internationally, collaborating regionally, implementing locally, and reduce number by half in 10 years”, and one of the most cost effective prevention measures is “TB drug therapy”. According to WHO DOTS guidelines, there are 5 elements: (1) Political commitment with increased and sustained financing. (2) Case detection through quality-assured bacteriology. (3) Standardized treatment, with supervision and patient support. (4) An effective drug supply and management system. (5) Monitoring and evaluation system, and impact measurement. Due to the insufficient of sputum sample collections, sample quality and collection kits, the case detection rate is very low. In order to accurately diagnose and provide right treatment to the patients, the sputum collections and its quality need to be improved. It is shown that in order to effectively control and break the infectious cycle, more than 70% of positive cases in the population need to be detected and more than 85% of those patients need to be treated.
There is a growing trend of TB prevalence in our county. Data shown in 2003 the incident rate was 73.77 in 100000 people, and the mortality due to TB was 9.27. To improve the detection rate in our county, we increased the sputum tests among the residents, and we found 342 positive cases in 2005. We intend to achieve effective TB prevention, adequate health education, sufficient management of the patients and the “DOTS” plan, and efficient implementation of “drug supply, drug administration, and depart after drug administration” policy. The goal of the disease prevention relies on: reduce infection, reduce drug-resistance, reduce TB relapse; by achieving this, we could reduce the new TB incident by 8-12% a year in our county and expect to achieve the “TB reduce by half within 10 years” target that set up by Department of Health, The Executive Yuen Division of Disease Control.
●Agency: Chunghua County Bureau Health
●Duration: April 1st 2006-December 31th 2006
Plan purposes: Implement “DOTS” strategies in order to reduce infection, reduce drug resistance, and reduce disease relapse.
●Plan goals:.
- Include all the positive sputum smear cases into this prevention strategy in our county, about 150 people.
- Incorporate local and area resources in order to re-enforce “monitor and treatment agency” function.
●Implementation:
- Case detection:
- Complete home visit and three sputum tests within 7 days notice to increase positive case detection rate.
- A positive case from sputum test will be confirmed by physicians within 3 days of positive test, and the case will be managed based on this proposed strategy.
- Confirmed cases include in “monitor and treatment plan” stage
- Hospitalization: Positive sputum cases and further confirmed TB patients that need to be quarantined should be categorized as patients that need to be involuntary hospitalization and need to be quarantined. The confirmed TB patients would be managed based on TB care guidelines during the hospitalization.
- Community monitor and treatment care: Those TB patients mentioned above once their sputum test indicate they are close TB cases, they would return to the communities and continue receiving treatment at homes. They would receive treatment and be monitored by the health providers that from local health clinics.
- Transition from hospitalization to community care: Prior to be discharged from the hospitals, the agent from the local clinic would visit the TB patient at least once while he/she was hospitalized. They would provide briefings to the patients regarding care after return home and they would consult with the health provider at the hospitals to be familiar with the case.
- Drug supply:
- Care providers would deliver the drug from “monitor and treatment agency” to the patients' homes in person, and they would implement “drug supply, drug administration, and depart after the drug administration” strategy.
- Patients pick up drug: use “community pharmacy” pharmacies to provide care and educate patients regarding drug side effects and its respond measures.
- Enforce team work:
- Organize monitor and treatment team in county level, our Bureau Health Commissioner will be the team leader, Disease Control Division Director will be the secretary, Disease Control Division third division, and Bureau Health employees will be surveillance agents. Their tasks include integrating our county TB prevention resource with welfare resource, hiring care provider and provide training to care providers, hosting monthly TB consultation workshops, supervising care providers' home visits, inputing home visit results into computers and reporting to Bureau Health on a weekly basis.
- Township health clinics' monitor and treatment team will be responsible for assisting patients' treatment, welfare resources, hosting weekly meeting to discuss the patients' progress from care providers, and reporting to Bureau Health if they encounter great difficulties in the communities. The Bureau Health will have physicians and agency workers go to the communities and interview the patients in order to address the issues.
- The Bureau Health will enforce the home visits provide by care providers. For new cases, the local care providers would have weekly visit in the first month, in the second month, the visit would be bi-weekly basis in order to ensure patients administrate drug correctly and ensure the success of “monitor and treatment strategies”.
- Organize monthly meeting “care provider case report”; will invite all care providers to attend the meetings and discuss cases they encountered, and report progress or difficulties in the field. The purpose of such meetings can help unify employees working for “monitor and treatment agency”.
- Criteria for care providers and number of people needed:
- Criteria:
- People who were public health nurses or worked in medical relate field would have priority.
- People who monitored TB patients and in good standing.
- Hiring: would based on county regulation.
- Number: would expect to recruit 10 people
- Trainings for monitor and treatment care providers
- Prior to the employment: at least 16 hours of training
- During the employment: at least 6 hours of training.
- The roles of monitor and treatment care providers:
- Once the care provider receive the notice of “completion of confirmed case procedures” , within 3 days, he/she should complete “monitor and treatment strategies” process.
- After discussion among treating physicians, case management agents and patients, and if the patient agrees to participate DOTS then the patient would sign a consent form and give the care provider the right to retrieve and keep the anti-TB medication on patient's behave.
- Follow doctors' order to provide patients monitor and treatment. If the patient is on daily medication, the care provider should monitor the drug administration at least 5 days a week.
- The care provider would bring anti-TB medication, DOTS diary, food stamp or food to meet patients at appointment and monitor the patient's drug administration.
- Monitor and evaluate the side effects from the medication and type and dose of the medication.
- Monitor patients' drug administration and evaluate patients and their family member's need in order to provide needed resource and assistant.
- Remind patients to provide sputum samples regularly based on our county's TB patient management strategies.
- Monitor and treatment care providers would report and discuss patients with local health clinic managers, supervisors and organize DOTS diary and input data into computers in order to keep track of the progress of monitor and treatment strategy.
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