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One way to cut costs for MDR treatment
The Adult Day Unit at National Jewish Hos pital in Denver offers a haven for TB patients who don’t need 24-hour nursing supervision but do need specialized treatment, says Gwen Huitt, MD, co-director of the unit. The unit serves a mix of patients, some suffering from atypical myco bac terial infections and others from multidrug-resistant TB, usually with the proportions tilted toward the former, she says.
One reason the unit was created was to cut costs, Huitt says. "Generally speaking, these patients are a little less ill, and they’re tolerating their medications fairly well," she says. That usually means they don’t need all three shifts of nursing care and can manage on their own between 5:30 p.m. and 7:30 a.m. However, if a need develops, nursing care is available immediately.
The first week of patients’ visits to the day unit, they are treated on an inpatient basis, and doctors see how well they tolerate their regimens. During their stay, they are housed on the hospital campus, Huitt stresses. "We’re not sending them out into the community to sit in a motel while they’re smear-positive. They are still spending the night here, even if they don’t need nursing services all night long."
Although it functions as one, the day unit isn’t just a cost-savings device, she says. "We have the luxury of being able to administer meds two, three, and four times a day. That helps when you’re searching for a regimen the patients can tolerate and not [vomit] all the time." Most patients at the hospital are referrals, in part for the simple reason that Colorado has few MDR-TB patients.
Along with enabling staff to provide attention to issues related to toxicity and side effects, the unit also affords a place where patients can receive therapy for the social, emotional, or drug-related problems, says Huitt.