Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

patient-centered approach to case management (enhanced DOT) have higher rates of
treatment completion than less intensive strategies. 8
Policy
Although most patients will undergo their initial evaluation and treatment in settings other
than a public health agency, a public health agency should undertake the major
responsibility for monitoring and ensuring the quality of all TB-related activities in the
community as part of its duties to protect the public health. 9
Effective TB case management requires administrative commitment and support. This
includes education, staff training, and ensuring adequate funding to maintain program
activities. 10 It is recognized that local public health agencies differ in their staffing and
organization and that no set of guidelines can cover all the situations that may arise
relating to case management. 11
For roles and responsibilities, refer to the “Roles, Responsibilities, and
Contact Information” topic in the Introduction 1.18.
In Alaska, regional and local public health nurses (PHNs) function as case
managers for each person with suspected or diagnosed active
tuberculosis.
All persons suspected or diagnosed with active tuberculosis need a
provider or medical home. The case manager should ensure that all
patients have a clinical provider to manage their TB treatment and care.
Directly observed therapy (DOT) is the standard of care for all persons
diagnosed with pulmonary tuberculosis in Alaska. It is also recommended
for all persons diagnosed with extra-pulmonary tuberculosis and is
provided free of charge.
PHNs should provide oversight for all persons taking anti-tuberculosis
medications for the treatment of LTBI. This may include: health education;
assessing adherence with the prescribed regimen; ordering medications;
arranging and monitoring DOT for high risk individuals; assessing for
adverse reactions; facilitating evaluation or diagnostic testing; and
reporting status and completion of treatment, as needed, to the Alaska TB
Program.
A L A S K A T B P R O G R A M M A N U A L Case Management 10. 3
R e v i s e d N o v e m b e r 2 0 1 2