A roundtable on the results of “The Implementation of an Optimal Model for Financing Outpatient Treatment of Patients and their Social Support as an Effective Method to Improve the Results of Tuberculosis Treatment in Ukraine” was held on December 22. The programme was implemented with the support of the Network and was carried out by the NGO Infection Control in Ukraine.
For the first time in Ukraine, financial mechanisms to contract primary care (family doctors) by the phthisiological service were developed to provide quality DOTS management of patients with sensitive tuberculosis. The project was implemented in the Chernihiv region and Zhytomyr.
Yurii Varchenko, the Network’s leading TB treatment specialist, noted that thanks to this project, there is already a developed mechanism to integrate the model of TB care financing into the state funding system and this mechanism is ready for use at the national level. In particular, the financing of a wide range of services to TB patients is planned through regional anti-tuberculosis services by means of involving all possible performers, including non-governmental organizations.
“Ukraine now has a unique chance to build a patient-oriented system, providing medical care to TB patients within the framework of reforming the general healthcare system. Our project together with partners proved that we did not have any national context that would not allow us to introduce the best world practices in controlling the epidemic of tuberculosis,” said the chairman of the NGO Infection Control in Ukraine Viktor Lyashko.
Mykola Deikun, the head physician of the Chernihiv Oblast TB Dispensary, the chairman of the permanent commission for health, social protection of the population and ATO participants of the Chernihiv Oblast Council, informed, “The Chernihiv region is the 7th among other regions in Ukraine in terms of the TB incidence. In 2016, the incidence among HIV/TB co-infection patients increased to 11.5 per 100 thousand population. Insufficient level of effective treatment and access to anti-tuberculosis care, especially for the rural population of the Chernihiv region, makes it necessary to look for new effective mechanisms to improve this situation. The project, initiated with the involvement of the primary care services, has made DOTS services more accessible for TB patients. A total of 69 patients of the 1-3 categories were involved in the Chernihiv region, 14 of them (20%) started treatment immediately from the outpatient stage. It should be noted that specialists of the phthisiological service increase awareness and confidence in the outpatient treatment model for tuberculosis patients.”
Patients have the opportunity to receive controlled treatment via Skype (20 people), in DOT-cabinets (592 people) and first aid stations in the Chernihiv region. In 2017, 75 people with sensitive tuberculosis were managed by the CO Chernihiv Network, 70 patients with resistant tuberculosis were treated with the help of the Red Cross Society. The project of the NGO Infection Control in Ukraine covered 8 districts of the Chernihiv region (Menskyi, Chernihivskyi, Borznanskyi, Ichnianskyi, Bakhmachskyi, Semenivskyi, Sosnitskyi, and Koryukivskyi). Multidisciplinary teams of district TB specialists, family doctors, and nurses were involved in this project. There was not any patient who interrupted treatment during the project and only for 2 patients the result of treatment was unsuccessful.
Thanks to the implementation of a financial mechanism to pay family doctor’s teams for the controlled treatment of TB patients and to provide incentives for treatment completion, family doctors gladly joined the work and would continue working in this direction with pleasure.
The main goal of the outpatient model of TB patients’ management is to prevent the formation and spread of drug resistance of Mycobacterium tuberculosis by reducing the risk of nosocomial infections. An essential advantage of the outpatient model is bringing medical care as close to the patient’s place of residence as possible. The implementation of an outpatient model of TB patients management improved the quality of preventive work in the outbreaks of tuberculosis infection, as well as improve systemic work with at-risk groups, in particular, with exposed persons.