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to the Consilium using the Consiliumex
5 .1 .1 Present cases for determination of outcome (cured, completed and failed) to the Consilium using the Consiliumex .
The clinical history of each patient who has fulfilled the ‘cured’, ‘treatment completed’ or ‘failed’ definition must be reviewed by the Consilium for approval of the final treatment outcome.
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The treating physician will fill out the discussion section of the Consiliumex and present the case to the Consilium as shown in the example below.
CONSILIUM DISCUSSION 010 – RECOMMENDATION ON TREATMENT OUTCOME TREATMENT OUTCOME AND SCHEDULE OF FOLLOW-UP ExAMINATIONS
INTENSIVE PHASE
Inclusive dates Oct 24, 2005 May 09, 2006 Latest regimen Z Km Ofx Pto Cs
CONTINUATION PHASE Inclusive dates May 10, 2006 May 10, 2007 Latest regimen Ofx Pto PAS
TREATMENT OUTCOME
Cured DATE OF LAST DOSE May 10, 2007 REASON Satisfied Criteria for cure
FOLLOW-UP ExAMINATIONS DATE ExAMINATIONS OTHERS
1ST FOLLOW-UP Nov 10, 2007 DSSM, CULTURE, CHEST X-RAY 2ND FOLLOW-UP May 10, 2008 DSSM, CULTURE, CHEST X-RAY 3RD FOLLOW-UP Nov 10, 2008 DSSM, CULTURE, CHEST X-RAY 4TH FOLLOW-UP May 10, 2009 DSSM, CULTURE, CHEST X-RAY
COMMENTS:
CONSILIUM OFFICER Ruth Orillaza - Chi, MD DATE May 3, 2007
5 .2 Record final outcome on Category IV Treatment Card
On the last page of the Category IV Treatment Card is a section to record the outcome. Note down the date of the designated outcome. For most patients, the date will be the day the last dose was taken. For patients with the interim outcome of transferred out, the final outcome will be noted on the last day of treatment at the Treatment Center that received the patient.
Note that a patient cannot be classified as “Cured”, “Treatment Completed” or “Failed” unless the Consilium has approved the designation. A patient with MDR-TB who completed treatment but did not have the necessary number of negative culture exams examinations can be classified only as “Treatment completed.” Likewise a patient who had a negative culture at baseline (within 30 days before and within 7 days after start of Category IV treatment) and has remained culture-negative all throughout treatment can be classified only as Treatment completed”.
A patient who has stopped coming for treatment for 2 consecutive months and cannot be located or cannot be convinced to resume treatment is classified as “Defaulted”. Therefore, do not mark this treatment outcome on a patient’s card until a patient has missed treatment for 2 consecutive months. The date when the last dose was given should be recorded as the date of the outcome.
When you transfer a patient from one treatment center to another treatment center to continue treatment, record the date and mark the outcome “Transferred out” on page 4 of the Category IV Treatment Card. You will inquire later about the treatment outcome of that patient from the Treatment Center that received the patient. When you learn the patient’s outcome from the receiving Treatment Center, record the final treatment outcome and the date of that outcome on the Category IV Treatment Card. Only if you cannot determine another outcome will you leave the outcome “Transferred out” with the date of the transfer.
If a patient was a transfer from another Treatment Center (registration group was “Transfer in”). The receiving Treatment Center registers the patient as Trans-in in the Category IV Register using the original Category IV Registration No. and will not be included in that Treatment Center’s cohort analysis because this patient’s treatment outcome must be reported to the referring Treatment Center.
Since cultures are used in order to define cures and failures, it is very important to collect sputum from each patient monthly. Without sputum culture results, a patient cannot be classified as cured.
The treatment outcome of every MDR-TB patient managed at the Treatment Site is an important information for monitoring the facility’s performance. For an MDR-TB patient who will be eligible for final treatment outcome, the case will be presented to the Consilium by the Treatment Center. After the outcome has been declared, the original Category IV treatment Card at the Treatment Site will be brought back to the Treatment Center. Later, this information on patient outcomes from all Treatment Sites will be analyzed as a measure of how well the Treatment Center is managing MDR-TB cases. A photocopy of the Category IV Treatment Card will remain at the Treatment Site.
Fill out the Category IV Register with the final outcome and the date of the last day the patient took the medicines.
Treatment outcome (17) Post-treatment follow-up monitoring (18) HIV status
Date of last intake of meds Ff up 1 Ff up 2 Ff up 3 Ff up 4 (19)
Cured
5 / 10 / 07
2
2
2
(18) Post-treatment follow-up Row 1: Date : mm/dd/yy
(19)HIV status
0-Negative Row 2: Symptoms: 1-Positive S- Symptomatic As- Asymptomatic 2-Unknown
Row 3: Smear/ culture result Row 4: CXR compared with last film done
1 - Improved 2- Progressed, specify using codes in (9) 3 - Stable
