![]() Evidence shows that treatment of TB should be initiated by a specialist and supervision of management should be as part of an multidisciplinary team, including primary care.ģ.12 GPs and primary care teams (including pharmacists) have a crucial role in the early detection of TB and, in collaboration with others, the overall care and treatment of their patients.ģ.13 All TB patients in Scotland should have their care plans reviewed by a TB multidisciplinary team. In practice this means that no TB patient should be treated by a single consultant without the involvement or oversight of a multidisciplinary team. Multidisciplinary teams also have a role in promoting and supporting local continuing professional development ( CPD) in respect of TB to ensure staff involved in patient care have up-to-date knowledge and skills.ģ.10 GPs have a key role in the early detection and treatment of TB and a primary care representative should be a member of local multidisciplinary teams.ģ.11 The view of the TB Action Plan Working Group is that the multidisciplinary team model of clinical care should be adopted across Scotland. ![]() Multidisciplinary team membership includes, as a minimum, every clinician treating TB in the geographic area covered by the team (including infectious disease, paediatric and respiratory specialists) every TB nurse in the area public health nurses involved in caring for TB patients Consultants in Public Health Medicine with TB lead microbiologists and pharmacists.ģ.9 The multidisciplinary team has a local leadership role, being responsible for developing local protocols based on national guidance, for supporting clinical audit of treatment, contact tracing activities, and for monitoring local morbidity and mortality. Meetings review the clinical and public health management of TB patients and so have a wider focus than traditional x-ray review meetings. This approach recognises that TB is a complex, multi-dimensional condition and that care of patients needs to take account of a range of clinical, social, occupational and other needs to ensure the best clinical outcomes.ģ.8 Multidisciplinary approaches involve regular scheduled meetings to review every TB patient being treated. ![]() Several Boards have already successfully introduced a multidisciplinary approach to TB care. Informal TB networks exist in most Boards, but the Clinical Services Subgroup agreed that a more formal multidisciplinary approach - of the kind that has been shown to be very successful in other complex clinical areas, such as cancer care - should now be universally adopted by TB services in Scotland. Other Boards with lower incidence of TB should however also review their response to TB in line with recommendations in this report.ģ.7 A key aim of this Action Plan is to improve the consistency and quality of care for TB patients across Scotland, removing inappropriate variation as far as possible in line with the Quality Strategy. Agreed systems and structures should be in place in all Boards, with an emphasis on multidisciplinary team-working, quality, audit, and shared TB learning on local, regional and national basis.ģ.6 The Working Group felt strongly that TB should be a Board priority for those areas in Scotland with the highest incidence of cases. ![]() However, it is vital to ensure that the quality of care that is delivered is of a high standard throughout Scotland, irrespective of the size of the Board or the number of TB cases seen per annum. In NHS Boards that have fewer cases of TB there has to date often been less of a clear focus on TB, both clinically and organisationally, than has occurred in some of the larger cosmopolitan Boards. The document is available at: ģ.4 The Clinical Services Subgroup considered a range of current issues in respect of treatment, care and management of patients, and provided advice to the TB Action Plan Working Group.ģ.5 The incidence of TB varies across Scotland. This relates to the critical role of TB clinicians (whatever clinical speciality) and TB specialist nurses but also to those who contribute to the management of patients through associated services.ģ.2 Clinical care of patients with TB can increasingly involve management of complex issues such as treatment of drug resistant strains of the bacteria or clinical care for those co-infected with HIV or with other serious co-morbidities.ģ.3 The Scottish Health Protection Network guidance Tuberculosis: Clinical diagnosis and management of tuberculosis, and measures for its prevention and control in Scotland, published in 2009, underpins approaches to clinical management of TB patients in Scotland. 3.1 Clinical services relate to the treatment, care and management at an individual level of those infected with TB.
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