Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

necessary to teach people how to take pills, or it may be necessary to crush the pills and
put them in food, such as pudding or applesauce. In addition, the case manager should
determine the need for enablers and identify incentives that will be most valuable to the
patient.
It is very important for case mangers to identify, document, and report
nonadherence with TB treatment and DOT to the Alaska TB Program as
soon as possible. If DOT aides are providing and observing patients
taking TB medications, they should also be instructed to report 2
consecutive missed DOT doses to the PHN case manager as soon as
possible.
Review psychosocial status to identify unmet needs, the use of alcohol and/or illegal
drugs, and any pre-existing psychiatric diagnoses. 24
Identify and document a good history of the patient’s social network. This is
important to identify and document in the event that the patient does not return for
follow-up. The case manager needs to verify the patient/family’s address, evaluate
residential stability, and assess potential for homelessness. Determine the patient’s
residence(s) during the past year, particularly any congregate living situations, such as
prison, jail, homeless shelter, nursing home, boarding home, or foster care. Establish
the patient’s occupation and/or student status, and document the name and address of
business or school. The name and location of a child’s babysitter, other caretakers,
daycare center, and/or school should be noted. In order to identify those who have
shared common air space with the infectious, untreated patient with TB, it is necessary
to have an understanding of the patient’s social and recreational activities and how
he/she spends leisure time. This includes time spent at bars, bingo, circuit parties, faithbased
functions, and other venues.
For more information see the Contact Investigation section of this manual
11.1.
A L A S K A T B P R O G R A M M A N U A L Case Management 10. 13
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