A collaboration between the local health department and community health centers (CHCs)

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A collaboration between the local health department and community health centers (CHCs) Boston Public Health Commission BPHC The board of health in Boston Mission: protect, preserve and promote health
A collaboration between the local health department and community health centers (CHCs) Boston Public Health Commission BPHC The board of health in Boston Mission: protect, preserve and promote health and well-being of Boston residents, particularly those who are most vulnerable BPHC TB Activities Case management for TB cases or suspects Diagnostic and therapeutic services for those with TB infection at the BPHC TB Clinic Treatment for cases ( active TB ) Treatment for those with latent infection BEFORE they progress to TB disease BPHC TB Clinic Facts Located at Boston Medical Center 7,000 to 8,000 patient visits annually Open 5 days a week English is the second language for the majority of those seen in TB Clinic BPHC staff are multilingual Hospital interpreters and/or language line used as needed BPHC TB Clinic Referrals Sources: Primary care providers Civil surgeons Occupational health departments MDPH Referral form : Provides important information about HPI Provides information re: significant PMH Referral forms can be found at Infectious disease bureau Tuberculosis clinic Referral form . Number of cases Number of TB Cases: Boston, Percent TB Cases by Birthplace: Boston, US Born Foreign Born Region of Birth for TB Cases: Boston, 2011 North America Europe Central/South America Carribean Asia Africa Percent Percent Length of US Residence for Foreign Born TB Cases Prior to TB Diagnosis: Boston, 1 year 1-5 years 6-10 years 10 years Who do Boston TB cases identify as their primary care site? 2010 N= N=44 Hospital outpatient clinic 26 (45%) 17 (39%) Community health center 16 (28%) 13 (30%) Private practices 2 (3%) 1 (2%) Other sites 4 (7%) 6 (14%) None identified 10 (17%) 7 (16%) Community Health Center Partners Selected based on risk of TB in their catchment population, interest, and ability to treat persons with LTBI South Cove Community Health Center Dorchester House Multiservice Center East Boston Neighborhood Health Center Joseph Smith Community Health Center Mattapan Community Health Center Harvard Street Neighborhood Health Center How the BPHC/CHC System Works CHCs identify those at risk for TB and perform a tuberculin skin test (TST) Persons with a significant TST response are referred to TB Clinic for an initial evaluation TB Clinic physician diagnoses and recommends treatment For those with LTBI (Class 2), all subsequent TB treatment is done at the referring CHC How the BPHC/CHC System Works Clinic visit notes are forwarded to the referring CHC Medication is either prepared by the BMC Pharmacy (one month supply) and sent to the health center OR the prescription is sent to the CHC Pharmacy (medications provided free of charge) Partnership with MDPH Per national guidelines, CHCs evaluate those on treatment monthly and have a control system in place so pharmacy will not release medications prior to the monthly evaluation How the BPHC/CHC System Works BPHC provides a protocol for monitoring persons on LTBI treatment and training for the partner CHCs The BPHC TB Clinic is available for technical consultation If problems arise during treatment at the CHC, the person is re-referred to the TB Clinic Records from monthly follow-up visits at the CHC are forwarded to BPHC Boston Resident LTBI Cases Seen at the TB Clinic, 2011 Those seen in the TB Clinic and diagnosed with LTBI are likely to be from racial/ethnic groups and neighborhoods with high TB case rates Implies that we are reaching the high risk groups Treatment of LTBI likely a contributing factor in the declining rate of TB disease in Boston residents Percent of Boston Residents with Latent TB Infection (N=1,373) Evaluated at the BPHC TB Clinic by Race/Ethnicity: % 9% 3% 5% 28% Asian Black Hispanic Other Unknown White 36% Percent Percent of Reported Tuberculosis Cases by Race/Ethnicity: Boston, White Black Hispanic Asian 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Rate per 100,000 Boston Residents with Latent TB Infection (N=1,375) Evaluated at the BPHC TB Clinic, Incidence by Neighborhood: TB Disease Incidence by Neighborhood*, Rate per 100,000 * Allston/Brighton, Back Bay/Beacon Hill/North End, East Boston, Fenway, Hyde Park, Jamaica Plain, Roslindale, Roxbury, South Boston & South End: 5 cases; Charlestown, West Roxbury: 0 cases TB Disease Incidence by Neighborhood*, 2010 South End South Dorchester Roslindale North Dorchester Fenway Allston/Brighton Rate per 100,000 * Back Bay/Beacon Hill/ North End, Charlestown, East Boston, Hyde Park, Jamaica Plain, Mattapan, Roxbury, & South Boston: 5 cases; West Roxbury: 0 cases What Works Expert TB assessment, diagnosis, and treatment recommendations (TB Clinic) Culturally and linguistically appropriate follow-up provided in a primary care setting (CHCs) Long term primary care relationships help ensure adherence to medication CHC setting is logistically easier for many during the (long) 9 month course of treatment (CHCs) Technical and clinic back-up is readily available (TB Clinic) Medications provided free of charge BPHC TB Clinic Clinic Location Boston Medical Center (BMC) 850 Harrison Avenue 3rd Floor Yawkey Building Phone (617) (appointments) Phone (617) (nurse triage) Fax: (617) Additional information:
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