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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