New form keeps track of wayward patients

Form becomes written resource for TB controllers

Clinicians at the University of California in San Francisco have developed a tracking form, which they say helps them keep tabs on homeless people and other members of marginal populations at high risk for getting lost to follow-up.

The aim of the tracking form is simple, says Jacqueline Tulsky, MD, associate professor in the department of medicine at the University of California in San Francisco: "It answers the question, If I needed to find you, how could I do it?’"

To get at that single, vital piece of information, Tulsky and her colleagues have developed a detailed, eight-page tracking form. That may sound like a time-consuming chore, but it’s often time well spent, she says. Interviewers often can get the information on two occasions: when someone comes in for the placement of a skin test, and when the subject returns to have the test read.

A written record

Though the form covers a wide range of information, including questions about a person’s three closest contacts, it’s quite different from the standard contact investigation, Tulsky notes. "This is the kind of thing that public health people and outreach workers have been doing for years without really thinking about it," she says. "What we’ve done is compile it and write it down." Written down, the form serves to remind and prompt interviewers to ask the right questions; in addition, it serves as a written resource that can be used by anyone, should a patient disappear.

"The advantage is that once you have the information on the form, anyone can pull it out of the chart and use it," she says. "They can read, for example, that [an infected] person’s mother lives in Bruno. Maybe he didn’t know her phone number, but he did give us the street where she lives. Plus, he goes to this food line three times a week . . . and so on."

Along with TB patients, the form works equally well for varied populations and under many different circumstances, Tulsky notes. At the moment, researchers in one project are using tracking forms to improve follow-up among candidates for prophylactic therapy who’ve been released from jail recently, a notoriously tough population to track.

Keeping up with such people "is totally hard," she concedes. "But what we’re finding [by using the tracking form] is, we’ve been able to improve follow-up from about 1% to about 33%."

Close contacts most often cited on the tracking form tend to be female relatives, especially mothers, she says. "That’s probably because women tend to be more stable and are less apt to be homeless or substance abusers," she notes. But moms, sisters, and aunts aren’t the only resources the form lists; sometimes, subjects turn out to have an e-mail address at the local library, an acquaintance who works the front desk of a shelter, or a needle-exchange site they visit frequently.

The form also prompts questioners to find out what agency or program, if any, acted as the referral agent. "One thing you want to find out is who sent this person to us," says Tulsky. "Why did they want to get screened in the first place?" Knowing whether a needle-exchange program or a drug treatment center referred someone is important information to have because it often offers a clue about where someone can be found.

To obtain a copy of the tracking form, readers may contact Tulsky’s assistant, Heather Long, at (415) 206-4982.