Syphilis Case Management Flashcards
What are the key functions of case management?
- Interviewing
- Field Investigation
- Case Analysis
Define:
Case Management
The process of systematically pursuing, documenting, and analyzing medical and epidemiologic case information for the purpose of identifying opportunities to develop and implement timely disease intervention plans.
Define:
Primary Disease Intervention
The process of preventing disease by treating persons who may have been exposed to infection but who, upon medical examination, have not yet developed S/S of activte disease, and whose lab results are negative or unknown at time of exam.
Referred to as epidemiologic treatment or prophylactic treatment. Doing this may stop the disease before it develops (while it’s still incubating).
Define:
Secondary Disease Intervention
The process of stopping the spread and complications of a disease.
(when the person is already infected)
Seven steps of case management
- Pre-interview analysis
- Original interview
- Post interview analysis
- Referral of sex partners
- Cluster interview
- Re-interview
- Case closure
What five things is the original interview meant to do?
- Assist in the management of infection
- Answer questions and tend to concerns
- Help avoid re-infection/re-exposure (or infection with another STD / HIV)
- Discuss how to handle others that may be involved
- Ensure confidentiality and make sure the patient / partner understands what that means
What is VCA?
Visual Case Analysis
Compares social / epidemiological and clinical / medical information about the index patient, with known information about the natural course of infection.
VCA is accomplished using the following:
- document medical and epi facts about infection
- analyze those facts
- identify opportunities for disease intervention
- Determine most likely hypothesis of disease transmission
- Develop a plan of action
The VCA chart benefits the case management process in the following ways:
- Allows partner services provider to compare info about each case to determine if commonalities exist
- Highlights informational gaps or conflicting information gathered during interview
- Presents info in a way that verifies source / spread relationships. This process is referred to as “ghosting”
- All info helps partner services determine next step to managing the case (including investigative priorities and activities)
seven basic facts of VCA chart
- Months of the year
- Patient name
- Reason for exam
- Medical history
- Symptoms
- Critical period
- Exposure dates
- These steps must be done in order
Critical period for early latent syphilis
12 months prior to the date of adequate treatment
Critical period for secondary syphilis
6 and a half months prior to the onset of symptoms
- 90 day incubation
- 5 week max duration of primary lesion
- 10 week maximum latency period
- 6 week maximum duration of secondary symptoms
Critical period for primary syphilis
From date of adequate treatment back three months prior to symptom onset (90 day max possible incubation period)
Non-reactive syphilis test within the standard critical period
If a syphilis patient has a non-reactive test sometime prior to diagnosis, they were either not infected at the time or were still in the incubation period. Not knowing which is true, the assumption is made that the patient was in the incubation period, and the critical period will begin four months and one week prior to the date of adequate treatment
Historical symptoms for positive syphilis case
If a patient has no symptoms at the time of diagnosis, but is able to give historical symptom, the critical period is developed from the historical symptom.
