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5/8/2017
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Educating Community Providers forSuccessful TB Treatment
Delphina Sanchez, MAMay 3, 2017
Essential Skills for the TB Nurse Case Manager Little Rock, ARMay 3‐4, 2017
Delphina Sánchez, MA has the followingdisclosures to make:
No conflict of interests
No relevant financial relationships with any commercial companies pertaining to this educational activity
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Essential Skills for the TB Nurse Case Manager
May 3‐4, 2017Little Rock, AR
EducatingCommunityProvidersforSuccessfulTBTreatment
DelphinaSánchez,MAMay3,2017
• Identify strategies for educating community providers to think TB.
• Identify strategies for developing good working relationships with health care providers in the community.
Objectives
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EDUCATING COMMUNITY PROVIDERS TOTHINK TB
Education
• Information on TB trends
Provide Resources
• Fact Sheets
• Just In Time Training
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Outreach to community providers may include:
• Needs assessment via survey or data review
• Periodic office visits and direct interaction to enhance communication and visibility
• Presentations at hospital in‐services, medical conferences, and grand rounds.
• Sponsorship and invitation to in‐services on TB, such as incidence and prevalence of TB in the community.
• Distribution of monthly newsletters and community alerts.
Outreach to Community Providers
TB TRENDS
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RESOURCES
CDC Division of Tuberculosis Elimination
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Tools for Health Care Providers
Self‐Study Modules on TB
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TB 101 for Health Care Workers
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This guide is useful for creating
• Fact Sheets
• FAQ’s
• Brochures
• Booklets
• Pamphlets
• Web Content
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• Identify intended audience
• Define key health problem/s or interest/s
• Engage intended audience; determine needs and level of knowledge
• Determine key concepts and messages
• Determine best way to communicate message
• Decide how to distribute material to audience
• Evaluate audience satisfaction and understanding
Developing Health Communication Materials
ResourcesCenters for Disease Control and Prevention, Division of Tuberculosis Elimination
https://www.cdc.gov/tb/
Find TB Resourceshttps://findtbresources.cdc.gov/
Heartland National TB Centerhttp://www.heartlandntbc.org/
NCHHSTP Program Collaboration and Service Integration (PCSI) https://www.cdc.gov/nchhstp/programintegration/Default.htm
Simply Puthttps://www.cdc.gov/healthliteracy/pdf/simply_put.pdf
TB Education and Training Networkhttps://www.cdc.gov/tb/education/Tbetn/default.htm
Tuberculosis Epidemiologic Studies Consortium (TBESC)https://www.cdc.gov/tb/topic/research/TBESC/default.htm
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Outreach to community providers may include:
A. A game of Scrabble with community providers
B. Periodic office visits and direct interaction to enhance communication and visibility
C. Needs assessment via survey or data review
D. B and C
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CREATING FACT SHEETS
• One page is best
• Make it readable ‐ use at least 12 point font
• Keep text brief
• Most important information in first paragraph (issue/action needed/label main message)
• Provide references for more information
Creating Fact Sheets (1)
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• Use pictographs and images where appropriate
• Use bullets when you can
• Leave plenty of white space
• Make very clear what you want them to do
• Provide all tools needed to take the action (email, tele, address)
Creating Fact Sheets (2)
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Information Graphics/Infographics
An information graphic is a visual representation of information or data, such as a
chart or diagram.
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easellyhttp://www.easel.ly/
Infogr.amhttp://infogr.am/
Piktocharthttp://piktochart.com/
Canvahttps://www.canva.com/
Infographic Tools
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Regarding high risk groups for TB, which of the following are the hardest hit populations?
A. African Americans
B. Asians
C. Hispanics / Latinos
D. All of the above
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JUST IN TIME TRAINING
Just‐in‐time training refers to making learning
available when needed by the learner, and at
the time that the learner needs the information,
knowledge or skill.
What is Just‐In Time Training?
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Convenient and accessible learning
• Personalizes learning
• Provided when and where needed
• Empowers learners to take charge of their own learning
• Expands offerings
• Quick and easy
Just‐In‐Time Online Training
1. Create a detailed road map
2. Pair each learning objective with training activity
3. Focus on relevant work‐related tasks and skills
4. Create a micro learning online resource library
5. Develop multiplatform‐friendly online training content
6. Incorporate real world online training content opportunities
7. Integrate social support
8. Make online assessments voluntary
Best Practices for Just‐In‐Time Online Training
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Self‐Study Modules on TB
https://www.cdc.gov/tb/education/ssmodules/default.htm
TB 101 for Health Care Workers
https://www.cdc.gov/tb/webcourses/tb101/default.htm
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DEVELOPING RELATIONSHIPS WITH
HEALTHCARE PROVIDERS IN THE COMMUNITY
Educate community clinicians on how to look for TB. Teach them to…”think TB”.
Educate community clinicians on the importance of referring their patients with TB and persons to be evaluated for TB to their local TB clinic.
As case managers, develop rapport with community clinicians because they will be assisting your patients with their co‐morbidities.
Community Clinician Providers
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• Understand your role, and the role of others in the multidisciplinary team
• Back up statements with facts
• Share information frequently
• Respect the person you are talking to
Principles of Good Communication (1)
• Use unambiguous language and speak clearly
• Foster a culture that promotes open communication
• Try to see the other person’s perspective
• Establish decision‐making protocols when possible
• Acknowledge and deal with conflict quickly
Principles of Good Communication (2)
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• Consider TB as a possible diagnosis
• Conduct patient evaluation
• Report patient evaluated for TB within one working day
• Refer the patient to the local health department for TB care
• Care for the patient until the health department takes over
Community Provider Responsibilities
Not only are you the local TB experts, you are trained to
provide case management and directly observed therapy
(DOT) ‐ the standard of care for all patients with TB
whether pulmonary or extra pulmonary ‐ you may also take
the lead on contact investigations to stop TB transmission in
your community. Lastly, you are legally responsible for
ensuring that patients with TB complete therapy.
Why Should Community Providers Be Encouraged to Refer Patients with TB?
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However, it is possible for healthcare providers and
the health department to co‐supervise a patient’s
TB care. To achieve this, both providers should
develop a TB Care Plan that ensures the patient
completes treatment meeting current standards of
care, has access to TB expertise and resources, and
is specific to individual patient needs.
Co‐Management
What has your experience been co‐managing
with a provider on a patient with TB?
Question
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Arkansas Department of Health4815 West Markham Street, Slot 45
Little Rock, Arkansas 72205Tele: 501‐661‐2152Fax: 501‐661‐2226
Email: [email protected]
http://www.healthy.arkansas.gov/programsServices/infectiousDisease/tuberculosis
Sometimes a community provider will insist on treating their own patient for TB.
See if he / she would be willing to allow you to perform DOT.
If they decline, analyze the situation. Are they uncomplicated and extra pulmonary or are they pulmonary and/or complicated?
Pick Your Battles (1)
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If provider insists on managing DOT, remind them that they are responsible for
• Monthly monitoring for DOT
• Reporting everything to TB Nurse Case Manager
• Ensuring patient completes treatment meeting current standards of care
Pick Your Battles (2)
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It is the community provider’s responsibility to:
A. Conduct a patient evaluation
B. Provide a medical history of the patient
C. Conduct a mental health assessment
D. Consider TB as a possible diagnosis
E. A and D
• How many hospitals are in your area?
• Visit hospitals and their Isolation Rooms
• Obtain contact information for the Infection Control Nurse at each hospital
• Build rapport with the Infection Control Nurse at each hospital
Hospitals
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Hospitals in Little Rock, ARHospital Infection Control Telephone
University of Arkansas Medical Sciences 501‐686‐8568
VA hospital 501‐257‐2652
Baptist Health 501‐202‐1921
St. Vincent Health Center 501‐552‐ 3585
Arkansas Children’s Hospital 501‐364‐1318
A Federally Qualified Health Center (FQHC) is a
designation from the Bureau of Primary Health Care
and the Centers for Medicare and Medicaid Services
given to a nonprofit public or private clinic that is
located in a medically underserved area or provides
care to a medically underserved population.
Federally Qualified Health Center
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Fostering Connections with FQHCs
By fostering connections between federally FQHCs
and other private primary care providers, states
may be able to connect Medicaid beneficiaries
with services needed to help them manage their
health and reduce costly visits to hospitals.
Fostering Connections with FQHCs (2)
FQHCs may find that by entering into collaborative
relationships with states and private practices, they
strengthen their own financial position, advance their
quality goals, improve their staffing mix, enhance the
continuum of care and the kinds of services available
to their patients, and further their mission.
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Can you name the FQHCs in your area?
Question Time
FQHC Address Tele
ARCARE11219 Financial Centre Parkway,
Suite 200Little Rock, AR 72211‐3873
501‐455‐2712
LITTLE ROCK COMMUNITY HEALTH CENTER
1100 N University Ave.Suite 125
Little Rock, AR 72207‐6343
501‐663‐0055
HOMELESS OPEN HANDS CENTER1225 Dr. Martin Luther King Dr.Little Rock, AR 72202‐4743
501‐244‐2121
COLLEGE STATION CLINIC4206 Frazier Pike
College Station, AR 72206501‐490‐2440
FQHCs in Little Rock, AR
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• Local Infection Control Practitioners
• Local Community Clinic Providers (Rehab/Nursing/Dialysis/County Jail/Shelters)
• Local Pulmonologists/Infectious Disease Providers
• Hospitals
• Federally Qualified Health Centers (FQHCs)
Networking
• Mutual trust and respect of roles between healthcare providers in the community
• Complete transparency throughout care
• Open communication
Important Things to Remember
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• Heartland National TB Center Staff
• Your Regional DSHS Staff
• Local Community Resources
Helpful Resources
• Plant the “Think TB” seed by providing TB education and resources.
• Use outreach, Fact Sheets, Just‐In Time training and Networking to start the conversation on TB.
• Cultivate relationships with community providers; make contact and exchange information.
• Use complete transparency throughout care and open communication, they are key to building rapport with community providers.
Review
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• CDC. CDC. Reported Tuberculosis in the United States, 2015. Atlanta, GA: U.S. Department of Health and Human Services, CDC, November 2016. Available at http://www.cdc.gov/tb/statistics/reports/2015
• Designed to Learn, Hatcher, Alex http://lpd.nau.edu/5‐reasons‐just‐time‐learning‐rocks/
• M. Takach and J. Buxbaum, Developing Federally Qualified Health Centers Into Community Networks to Improve State Primary Care Delivery Systems (Portland, Maine, and New York: National Academy for State Health Policy and The Commonwealth Fund, May 2011).
• Public Image Health Library https://phil.cdc.gov/Phil/home.asp
References
Dora Marrufo, RN, BSNNurse Supervisor
City of San Antonio Chest Clinic
Acknowledgements
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