OS 213: Human Disease and Treatment 3 (Circulation and Respiration)

LEC 09: TB DOTS

Exam 3 | Grace Rondillo, RN | 04 February 2013
OUTLINE
I. UP PRIME TB DOTS
A. General Data
B. History
C. Current Epidemiology
D. System of Care
II. Forms Used
A. Intra-Hospital TB Referral Form
B. NTP Referral from Hospitals Form
C. MDR-TB Suspects Referral Form

III.TB in the Philippines

A. Association with Co-Morbids
B. Rise in MDR-TB
C. Stigma Still Present

Speaker is Nurse Grace Rondillo, head nurse of OPD Small Clinics (such as allergy, TB DOTS,
Drug Test, etc.)

UP PRIME TB DOTS
General Data
PRIME TB DOTS - PGH Responsive Integrated Multi-Disciplinary
Enhanced TB DOTS (Tuberculosis Directly Observed Treatment,
Short-course); coined by Dr. Berba
TB DOTS is tutok gamutan, free medicine for TB
Head nurse is Grace Rondillo
Location is near ER/OPS (to avoid spreading of the disease)

History
Only started to have a clinic for TB DOTS in 2010
o PGH director isnt fond of it (TB DOTS), kasi pang health center
lang daw iyun, pero tertiary center daw ang PGH
o But more and more complicated cases of secondary TB is found in
the hospital; many times operations are performed on TB
patients when the TB meds would suffice
o were gearing towards becoming a TB DOTS providing hospital,
instead of just a referring hospital
o But having problem for that goal now because mag-isa lang si
Maam Grace
o Staff needed
Dr. Roa is the head of the TB Clinic
WHO Invovlement
o Funding, drugs, salary provided by the WHO
o WHO still considers the Philippines as a TB burdened country
o WHO closely monitoring the TB situation in the country
Current Epidemiology
rd
st
nd
Philippines 3 most burdened TB country, (1 is India, 2 is China)
Rise in the cases of extrapulmonary TB in hospitals
o Potts Disease (spinal TB), TB arthritis, TB meningitis, TB adenitis..
o takes longer to treat (1 year)
o before TB mostly seen in health centers, now many cases in
hospitals
o many afraid to go to the health center because of stigma, rather
go to hospital for treatment
o many new cases of medical students, residents (especially in Dept
of Medicine, Dept of Neuro from performing intubation without
masks)
o many having TB as a co-morbid to their chief complaint as a
secondary infection
System of Care
Requires positive AFB smears and X-ray
For Sputum Positive Patients
Needs at least 2 out of 3 positive AFB smears
o minimum of three smears performed
o gold standard
For Sputum Negative Patients
Assessed by TB-DC: TB Diagnostic Committee
o To treat or not to treat, they are the ones who decide
o Consists of 1 pulmo IDS consultant, 1 radiologist & 1 manila
health department representative
o they will rely on X-ray/radiologic findings
o if its not TB and they treat, will do more harm than good

PattiDOTS, DOTSy Lenny, DOTSper

FORMS USED
Intra-Hospital TB Referral Form (Green Form)
used to be color blue but changed to green (blue is the color of
death certificate)
used for patients coming from the Wards or OPD
First page contains general data of hospital case, referring physician,
patient information, patient history, diagnostic exam resuts and
diagnosis of referring service (to be filled out by the attending
physician)
Second page is a return-slip (to be filled out by pulmo IDS fellow)
with patient information, referring unit information, recommended
actions (type of treatment, single drug treatment options for
patient with liver/kidney problems, referral to TBDC if applicable or
referral to DOTS facility)

NTP Referral from Hospitals Form (Yellow Form)

used to specifically refer patients to health centers
includes info of referring hospital, patient information, reason for
referral, classification of patient (pulmonary, extrapulmonary), type
of patient (new, failure, RAD, relapse, transfer in, other), category of
treatment [category I, II, III, IV (MDR-TB)]
has a return-slip at the bottom to be filled up by receiving DOTS
facility/health center to let the referring hospital know that the
patient was accommodated
MDR-TB Suspects Referral Form (White Form)
used for referring patients suspected to have MDR-TB to Treatment
Hubs (since PGH not a providing hospital yet)
contains patient information, referring health facility, referred
treatment hub information, reasons for referring MDR-TB suspect,
and TB history & treatment of patient
Treatment Hubs: Quezon Institute, Lung Center of the Philippines,
Tala in Caloocan, La Salle Treatment Hub in Cavite (has costs but
minimal)
TB IN THE PHILIPPINES
Association Co-Morbids
HIV
PGH is already a treatment hub for HIV
high prevalence of TB in HIV patients already proven
Diabetes
Studies on-going on association with Diabetes
Observations of close association at the moment
Rise in MDR-TB
MDR-TB
TB can ordinarily can infect 5 persons in one sneeze, but in MDR-TB
even the whole room
more contagious, must wear protective masks (N95)
problem of doctors diagnosing numerous presentations as TB right
away, patients also self-medicating or not undergoing full treatment
Stigma Still Present
Stigma preventing many patients from going to the health center
for treatment (tsismis ng mga ka-barangay)
Quezon Institute: Some patients, even if well already, still dont
want to go home because of the family maintaining the stigma
against them. Some are transferred to Lung Center just so they
dont have to go home, but theres cost involved there
Government making effort to address the stigma by saying that TB
is treatable, that medicines are available

UPCM 2016A: XVI, Walang Kapantay!

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OS 213

LEC 09: TB DOTS

Maams concerns: Dont get sick, youd be out for months.

Technically, if youve been taking the meds for 2 weeks you are noncontagious, but negative sputum tests necessary to go back to school.

Jasper:

END OF TRANSCRIPTION
Patti: Hello 2016! Good Luck sa exams andAdvanced Happy
Valentines sa inyong lahat ^_^

Leonard:
nd
Shout out to the cool kids of the 2 row of the east! =)

God bless everyone on the exam!=)

Patti, Leonard, Jasper

UPCM 2016A: XVI, Walang Kapantay!

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