2.50
Hdl Handle:
http://hdl.handle.net/10755/157852
Type:
Presentation
Title:
Impact of Nurse Case Management on TB Compliance Among Homeless Adults
Abstract:
Impact of Nurse Case Management on TB Compliance Among Homeless Adults
Conference Sponsor:Western Institute of Nursing
Conference Year:2006
Author:Nyamathi, Adeline, PhD, ANP, FAAN
P.I. Institution Name:University of California Los Angeles
Title:Professor and Associate Dean for Academic Affairs
Contact Address:School of Nursing, 700 Tiverton Ave., Box 951702, Los Angeles, CA, 90095-1702, USA
Contact Telephone:310-825-8405
Co-Authors:Ashley Christiani, MD; Lillian Gelberg, MD; and Donald Morisky, ScD
Studies have shown dramatic increases in TB among homeless individuals over most of the past decade, with rates of PPD positive skin tests ranging from 18% to 51% and active TB disease from 1.6% to 6.8%. Independent factors associated with TB among homeless adults include injection drug use (IDU), greater age, and time spent in shelters. Purpose: Evaluate the effectiveness of a theoretically-based intervention program focused on compliance with TB chemoprophylaxis treatment among sheltered homeless adults in Los Angeles. Method: A total of 518 homeless adults, who met eligibility criteria and resided in emergency or sober living shelters, were invited to participate in a 6-month TB Chemoprophylaxis study from May 1998 to June 2003. Participants were randomized by shelter to a culturally competent Nurse Case Managed (NCM) or a Standard Care TB Chemoprophylaxis and HIV risk reduction program that was based upon the Comprehensive Health Seeking and Coping Paradigm. Participants completed both baseline and six-month assessment of extensive battery of instruments including sociodemographic variables and drug and alcohol use. Reliability and validity of the instruments were well established. Results: The majority of the participants were male (80%), and African-American (81%) with a mean age of 41 (SD 8.6); 98% of participants completed the 6-month follow-up questionnaire. Both groups were paid $5 for taking each of 52 doses of INH. Participants in the NCM group were significantly more likely to complete the 6-month TB chemoprophylaxis compared to those in the Standard group (72% vs. 46%, respectively; p< .001). Participants in the Standard Care group who reported IDU in the past six months or ever use of IDU were more likely to be retained than their counterparts in the NCMI group (59% vs 27% and 57% vs 31%, respectively). Similarly, Standard Care participants who reported lifetime alcohol use were more likely to be retained than participants in the NCMI group (51% vs 41%). Conclusions/Implications: Nurse case management, implemented by culturally-sensitive nurses and outreach workers, appears to effectively modify completion of TB Chemoprophylaxis among a difficult to recruit and retain population. These study findings lead to an evolving knowledge base that promotes expert clinical practice. This study was supported by a grant from the National Institute on Drug abuse, 1 R01 DA11145.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleImpact of Nurse Case Management on TB Compliance Among Homeless Adultsen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157852-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Impact of Nurse Case Management on TB Compliance Among Homeless Adults</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2006</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Nyamathi, Adeline, PhD, ANP, FAAN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of California Los Angeles</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Professor and Associate Dean for Academic Affairs</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">School of Nursing, 700 Tiverton Ave., Box 951702, Los Angeles, CA, 90095-1702, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">310-825-8405</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">anyamath@sonnet.ucla.edu</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Ashley Christiani, MD; Lillian Gelberg, MD; and Donald Morisky, ScD</td></tr><tr><td colspan="2" class="item-abstract">Studies have shown dramatic increases in TB among homeless individuals over most of the past decade, with rates of PPD positive skin tests ranging from 18% to 51% and active TB disease from 1.6% to 6.8%. Independent factors associated with TB among homeless adults include injection drug use (IDU), greater age, and time spent in shelters. Purpose: Evaluate the effectiveness of a theoretically-based intervention program focused on compliance with TB chemoprophylaxis treatment among sheltered homeless adults in Los Angeles. Method: A total of 518 homeless adults, who met eligibility criteria and resided in emergency or sober living shelters, were invited to participate in a 6-month TB Chemoprophylaxis study from May 1998 to June 2003. Participants were randomized by shelter to a culturally competent Nurse Case Managed (NCM) or a Standard Care TB Chemoprophylaxis and HIV risk reduction program that was based upon the Comprehensive Health Seeking and Coping Paradigm. Participants completed both baseline and six-month assessment of extensive battery of instruments including sociodemographic variables and drug and alcohol use. Reliability and validity of the instruments were well established. Results: The majority of the participants were male (80%), and African-American (81%) with a mean age of 41 (SD 8.6); 98% of participants completed the 6-month follow-up questionnaire. Both groups were paid $5 for taking each of 52 doses of INH. Participants in the NCM group were significantly more likely to complete the 6-month TB chemoprophylaxis compared to those in the Standard group (72% vs. 46%, respectively; p&lt; .001). Participants in the Standard Care group who reported IDU in the past six months or ever use of IDU were more likely to be retained than their counterparts in the NCMI group (59% vs 27% and 57% vs 31%, respectively). Similarly, Standard Care participants who reported lifetime alcohol use were more likely to be retained than participants in the NCMI group (51% vs 41%). Conclusions/Implications: Nurse case management, implemented by culturally-sensitive nurses and outreach workers, appears to effectively modify completion of TB Chemoprophylaxis among a difficult to recruit and retain population. These study findings lead to an evolving knowledge base that promotes expert clinical practice. This study was supported by a grant from the National Institute on Drug abuse, 1 R01 DA11145.</td></tr></table>en_GB
dc.date.available2011-10-26T20:15:58Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T20:15:58Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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