Psychosocial Barriers Impacting TB Treatment

Transcription

1 Psychosocial Barriers Impacting TB Treatment Rachel Bauman, M.S., CTRS September 14, 2017 TB Nurse Case Management September 12 14, 2017 EXCELLENCE EXPERTISE INNOVATION Rachel Bauman, M.S., CTRS has the following disclosures to make: No conflict of interests No relevant financial relationships with any commercial companies pertaining to this educational activity 1

2 Psychosocial Barriers Impacting TB Treatment BY: RACHEL BAUMAN, M.S., CTRS TEXAS CENTER FOR INFECTIOUS DISEASE What is Recreational Therapy and why is it relevant to TB treatment? Recreational Therapy/Therapeutic Recreation: A treatment service designed to restore, remediate and rehabilitate a person s level of functioning and independence in life activities, to promote health and wellness as well as reduce or eliminate the activity limitations and restrictions to participation in life situations caused by an illness or disabling condition - American Therapeutic Recreation Association (ATRA). 2

3 *Psychosocial Factors* Psychosocial factors are influences that affect a person psychologically or socially. Understanding how psychosocial factors impact TB treatment is crucial for the following reasons: 1. Quality of Life of patient 2. Impact on family 3. Providing the highest level of care to patient 4. Public Health Welfare 5. Prevent future reoccurrence of disease or resistance Psychosocial Factors: The Big 4 Homelessness Tuberculosis Treatment Socioeconomic Substance Abuse Mental Illness 3

4 Complicating Factors Impacting TB Treatment Cultural Impact Language Location of Delivery of Service Rapport with Medical Staff Communication Style Health Habits/diet Mental Health Motivation Feelings of Hopelessness Isolation/Loneliness Understanding of Prognosis Stigma Alcohol & Substance Use Social Exclusion & Stigma Health comorbidities Experience with TB Treatment Family Support Job Security Poverty Government/Institutional Policies Inadequate Housing Institutionalization Pharmacological Barriers Legal Status Recreational Therapy Interventions in patients with Tuberculosis Psychosocial Factors addressed by Recreational Therapy during TB treatment: Skills related to independence, focus, leisure education, hopelessness, reported feelings of depression, anxiety, and stress, substance abuse, active engagement, feelings of isolation/loneliness, and community integration Current Interventions implemented: 1:1 sessions, groups, art, yoga, AAT, physical activity, gardening/horticulture therapy, and community integration outings 4

5 Implications of Psychosocial Factors on Diagnosis and Treatment Erratic behavior Old behaviors Social isolation Impaired judgement Additional Stigma Lowered selfesteem Mental Illness Homelessness Poor ventilation Overcrowding Risky behaviors Long contact with disease Unstable shelter Unstable support systems Substance Abuse Socioeconomic Family strife Increased stress Job security Fear Access to healthcare TB according to Maslow Where are your patients when you meet them? Why is this important? What are possible barriers to their recovery? What can you do to assist them on their path to wellness and recovery? 5

6 TB Provider Expectations Rapport, rapport, rapport! Use empathy and compassion Practice professional boundaries and refrain from personal bias Be knowledgeable Don t take it personal Provide highest quality care to patients who need you Encourage patient to focus on his/her health and getting better Take care of yourself. Burn out is real and caring for patients is exhausting. Make time for you TB Case Study Location: Texas Center for Infectious Disease; San Antonio, Texas Patient: 38 y/o court ordered African American male dx with pulmonary TB with history of Schizophrenia, substance abuse, periods of homelessness, nonadherence to treatment, incarceration, hospitalization, low SES, and high risk behaviors. Areas of need: Erratic mood, noncompliance to medication, elopement, isolation, strained relationship with providers, poor hygiene, poor communication, and poor social skills. Intervention: CTRS met with patient 3x/week for 45 minutes per session for a period of 3 months working on increasing social engagement, improving rapport with providers, quality of life (QOL), compliance to directives/rules, increasing independence, and increasing social skills. CTRS facilitated the session by playing the game of Uno and allowing patient to select his own music to decrease agitation, build independence, reminisce his past at home, and goals for the future. Outcomes: Pt. completed 9 month treatment at TCID while his confidence increased, he reported hope for the future, and appeared mentally and physically stable. 6

7 Resources American Therapeutic Recreation Association- Texas Center for Infectious Disease- References Deiss, R., Rodwell, T., & Garfein, R. (2009). Tuberculosis and Illicit Drug Use: review and update. Clinical Infectious Diseases, 48 (1), Fogel, N. ( 2015). Tuberculosis: A disease without boundaries. Tuberculosis, 95 (5), Khan, J., Aslam, F., Khan, B., Anjum, S.I., Rehan, F.U., Shams, W.A., & Ahmad, Z. (2015). A Study of Socio-Economic Status (SES) Associated with Epidemiology of Tuberculosis in General Population of District Buner, Khyber Pakhtunkhwa (KPK, Pakistan. Open Access Library Journal, 2:e Pachi, A. Bratis, D., Moussas, G., & Tselebis, A. (2013). Psychiatric Morbidity and Other Factors Affecting Treatment Adherence in Pulmonary Tuberculosis Patients. Tuberculosis Research and Treatment, Santos de Araujo, G., Pereira, S.M., Neves dos Santos, D., Marinho, J.M., Rodrigues, L.C., & Barreto, M.L. (2014). Common Mental Disorders Associated with Tuberculosis: a matched casecontrol study. PLOS One, 9 (6): e United States. Centers for Disease Control and Prevention. TB in the Homeless Population. Atlanta, GA: CDC,