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Table 5 Guide to classification of patients to Enhanced Case Management levels used in TBCA

From: Quantifying the need for enhanced case management for TB patients as part of TB cohort audit in the North West of England: a descriptive study

ECM level

Clinical factors

TB specific

Social factors

0

Physically able to self-medicate

No central nervous system impairment

Positive IsoScreen at reviews

Correct tablet count at reviews

Contact tracing requirements limited to adults in the same household

No stigma related issues

No language barriers

No housing or finance issues impacting on treatment

1

Elderly to monitor for side effects

Children to ensure compliance of child and parent/carer

Requires GP or community pharmacy input for blister packs to check correct doses

Taking complex medications e.g. HIV medications

Disease site e.g. smear positive pulmonary or central nervous system disease

Contact tracing requirements in various areas and/or settings e.g. patient out of area, workplace, community group settings

Stigma that can be dealt with through one-to-one education

Requires interpreter for first visit but has some understanding of English

Requires signposting for benefits and/or financial issues

Patient difficult to reach e.g. no front door bell, more than 1 address, problems getting time off work/college, refusal of home visits

2

Having complex side effects requiring LFT monitoring

Needs more regular prompting with medications e.g. blister packs, regular IsoScreen, tablet counts

HIV and TB co-infection and starting both anti-retroviral and TB medications at the same time

Single drug resistance

Transmission within contacts or children who are contacts

Stigma that requires more formal education e.g. through community centres or workplaces

Financial difficulties that may affect treatment compliance e.g. attending clinic, poor nutrition, poor heating

Language barriers throughout treatment requiring easily accessible interpreter at each visit either face to face or by phone

Alcohol and/or drug dependency without LFT derangement

Patient difficult to reach e.g. DNA at clinics, not home for reviews

3

More than one drug resistance

Needs reintroduction of medications e.g. due to deranged LFT’s

Complex contact tracing e.g. transmission to children, vulnerable groups, extensive transmission

Involvement of PHE for workplace or community screening

Difficult language barriers throughout treatment

Homelessness or housing issues due to finance

Illegal immigrants, difficulty accessing benefits

Potentially dangerous patients where more than one person is required to visit

Children who DNA and where social service involvement is required

Patient difficult to reach e.g. consistent DNA at clinics, consistently not home for reviews