TB Control Strategies in Michigan

Peter Davidson, Ph.D.Peter Davidson, Ph.D.

TB Program CoordinatorTB Program Coordinator

Michigan Dept. Comm. HealthMichigan Dept. Comm. Health

OverviewOverview

Michigan TB overviewMichigan TB overview– Specific difficulties in MISpecific difficulties in MI

Training coursesTraining courses

TB nurse networkTB nurse network

Strategies / ideas for futureStrategies / ideas for future

Michigan TB OverviewMichigan TB Overview

Reported TB Cases and Rates Reported TB Cases and Rates Michigan, 2001 - 2006Michigan, 2001 - 2006

* Cases per 100,000. MI population 9.9 million as of 2000 census

YearYear CasesCases Rate*Rate*

20012001 329329 3.33.3

20022002 315315 3.13.1

20032003 243243 2.42.4

20042004 272272 2.72.7

20052005 246246 2.42.4

20062006 221221 2.22.2

TB Burden, Michigan Counties, 2006TB Burden, Michigan Counties, 2006

Population Density,Population Density,Michigan Counties, 2000Michigan Counties, 2000

Michigan Health DistrictsMichigan Health Districts

Specific Difficulties in MichiganSpecific Difficulties in Michigan

LHDs often short-handedLHDs often short-handed– Staff spread too thin to focus on TBStaff spread too thin to focus on TB– Staff turn-over prevents solid knowledge baseStaff turn-over prevents solid knowledge base

Maintaining focus on TBMaintaining focus on TB– We still have TB???We still have TB???– Very few LHDs have staff or funding dedicated to TB prevention, Very few LHDs have staff or funding dedicated to TB prevention,

education or controleducation or control– TB responsibilities often integrated with CD, Imm, WIC or other TB responsibilities often integrated with CD, Imm, WIC or other

programs.programs.

LHD staff lack resources, time and support to educate or LHD staff lack resources, time and support to educate or update themselves about TBupdate themselves about TB

LHDs operate autonomously, no standardized forms or LHDs operate autonomously, no standardized forms or procedures between LHDs.procedures between LHDs.

Specific Difficulties in Michigan:Specific Difficulties in Michigan:SummarySummary

A case may easily become a crisis.A case may easily become a crisis.

Michigan TB TrainingsMichigan TB Trainings

Michigan TB Trainings: OverviewMichigan TB Trainings: Overview

Initiated in 2002Initiated in 2002Goal: Maintain expertise by providing educational Goal: Maintain expertise by providing educational opportunities to LHDs on core principles and opportunities to LHDs on core principles and practices of TB controlpractices of TB controlFour training modules availableFour training modules available– TST (Train-the-trainer also available)TST (Train-the-trainer also available)– Case ManagementCase Management– Contact InvestigationContact Investigation– DOTDOT

Fit testing for N-95 masksFit testing for N-95 masks

Michigan TB Trainings: ImpactMichigan TB Trainings: Impact

CourseCourse Date Init.Date Init.Times Times

OfferedOfferedNumber of Number of ParticipantsParticipants

TSTTST 7/037/03 423423 4,8564,856

TST-TTTTST-TTT 7/037/03 148148 421421

CICI 8/028/02 1818 242242

CMCM 7/037/03 1111 153153

DOTDOT 10/0610/06 33 6464

N-95N-95

Fit TestFit Test2/022/02 3131 461461

Michigan TB Nurse NetworkMichigan TB Nurse Network

Michigan TB Nurse Network:Michigan TB Nurse Network:Why Focus on Nurses?Why Focus on Nurses?

Nurses are the basis for quality patient care.Nurses are the basis for quality patient care.

> 85% of all public and private healthcare is directly > 85% of all public and private healthcare is directly administered through nursesadministered through nursesNurses are trained to manage a patient’s care during Nurses are trained to manage a patient’s care during major and subtle health issuesmajor and subtle health issues– Assess, monitor & diagnose pt’s statusAssess, monitor & diagnose pt’s status– Recommend & deliver medsRecommend & deliver meds– Provide & document case managementProvide & document case management– Integral to quality patient careIntegral to quality patient care

Michigan TB Nurse Network: Michigan TB Nurse Network: PurposesPurposes

Provide updates and education regarding state and national TB guidelines

Provide a forum for discussion of TB case management

Link novice TB nurses with experienced and knowledgeable TB nurses: friendly developmental networking

Increase MDCH TB Control staff awareness of educational needs, barriers and challenges faced by LHD staff

Improve partnership and collaboration between LHDs, MDCH, non-profit and private health care entities

Increase understanding and use of MDCH TB laboratory by LHDs.

Michigan TB Nurse Network:Michigan TB Nurse Network:Brief HistoryBrief History

Originally 12 counties in SE MichiganOriginally 12 counties in SE Michigan– First meeting 3/05, 5 nurses and 1 supervisorFirst meeting 3/05, 5 nurses and 1 supervisor

Currently 14 counties from central and lower Currently 14 counties from central and lower Michigan, 28 membersMichigan, 28 members

Nurse Network meetings held quarterly in Lansing Nurse Network meetings held quarterly in Lansing (centrally located).(centrally located).

Michigan Health DistrictsMichigan Health Districts

Michigan TB Nurse Network: Michigan TB Nurse Network: ProductsProducts

Quarterly interdisciplinary discussion of TB case managementQuarterly interdisciplinary discussion of TB case managementInclusion of TB training in the curricula of academic partners Inclusion of TB training in the curricula of academic partners educating health care professionalseducating health care professionals

– Mott Community CollegeMott Community College– Glen Oaks Community CollegeGlen Oaks Community College– Oakland UniversityOakland University– Michigan State UniversityMichigan State University– University of MichiganUniversity of Michigan

Linkages w/ advocacy partners also at MDCHLinkages w/ advocacy partners also at MDCH– MDCH Immunizations: collaboration for exhibitions; immunization MDCH Immunizations: collaboration for exhibitions; immunization

toolkit featuring TB materialstoolkit featuring TB materials– MDCH Office of Drug Control Policy: Staff at substance abuse centers MDCH Office of Drug Control Policy: Staff at substance abuse centers

have rec’d training to interpret TSThave rec’d training to interpret TST

Michigan TB Nurse Network:Michigan TB Nurse Network:In ProcessIn Process

TB Toolkit as resource for health care workersTB Toolkit as resource for health care workers– Concise, step-by-step guide for TB case management from Concise, step-by-step guide for TB case management from

initial determination of case to completion of therapyinitial determination of case to completion of therapy

Program evaluation of TST courseProgram evaluation of TST course– On site observation of TST courses to evaluate the course On site observation of TST courses to evaluate the course

as it is presented and the instructor. Overall feedback from as it is presented and the instructor. Overall feedback from the instructors has been very positivethe instructors has been very positive

AcknowledgementsAcknowledgements

Gail Denkins, RN, BSGail Denkins, RN, BS Nurse EducatorNurse Educator

Julie McCallum, RN, MPHJulie McCallum, RN, MPH Nurse EducatorNurse Educator

Andrew Knecht, MPHAndrew Knecht, MPH TB EpidemiologistTB Epidemiologist

Tracina Cropper, BSTracina Cropper, BS CDC PHACDC PHA

Thank you!Thank you!

Questions?Questions?

Getting Buy-In: Tips and HintsGetting Buy-In: Tips and Hints

Exhibit Exhibit oftenoften

Keep the Keep the web currentweb current

Cancel class for Cancel class for lack of interestlack of interest

CommunicateCommunicate

InviteInvite InviteInvite

InviteInvite And Invite And Invite again!again!

Offer Offer varietyvariety

Offer the Offer the easy buttoneasy button

Offer Offer optionsoptions

Offer foodOffer food