A very insidious disease is tuberculosis. Both an adult and a child can become infected. Therefore, any citizen of our country must undergo a mandatory examination, which will detect or deny the presence of infection with mycobacteria.
If infection is confirmed or the results are doubtful, then the patient receives a referral to a TB dispensary. This is an institution where additional examinations will be carried out and, if necessary, complex treatment is prescribed. Moreover, there are certain groups of dispensary registration for tuberculosis, which are designed to individualize each patient or patient at risk. Groups are assigned according to regulatory medical documents. Their qualifications will be considered in this article.
Brief definition
Dispensary registration groups for tuberculosis are unique cells that imply a different form of the disease and the severity of its course. Before treating a patient, a TB specialist (a doctor involved in the diagnosis and treatment of tuberculosis), according to the law, is obliged to refer a person to a certain group. This makes it possible not only to formally diagnose, but also to prescribe an individual treatment to the patient, which helps to quickly stop all symptoms and increase the chances of a speedy recovery.
There are four groups of dispensary registration for tuberculosis, which are divided into subgroups. Patient's affiliation to one of them should be based only on the treatment and epidemiological principle. At the same time, the Ministry of Health of the Russian Federation regularly reviews all existing groups and makes changes.
The order No. 109 regulates all dispensary registration groups for tuberculosis. The document was adopted back in 2003, and in 2017 underwent some changes. It, in particular, states that all measures aimed at combating tuberculosis are justified and expedient.
Clinical care groups for tuberculosis
Consider the accounting group and the affiliation of patients to them. All of them, as already mentioned, four:
1. The first. This group includes all healthy people. The category of patients is subject to examination once a year. The research package includes:
- general analysis of blood and urine;
- blood glucose test;
- gynecological examination for women;
- ECG for people over 40;
- fluorographic examination.
2. The second. Patients who have had uncomplicated diseases. If the patient had a sore throat, then monitoring should last one month, with pneumonia - one year, and after glomerulonephritis - two years.
3. The third. This includes all patients with chronic diseases in remission.
4. The fourth. People with chronic pathologies who are in the acute stage.
In the clinical examination of children and adults, slight differences are implied. People who have come of age undergo regular examinations in order to identify the disease at an early stage and successfully treat it.
Why register
Dispensary registration groups for tuberculosis in adults are necessary not only for the classification of patients. They put a person on record and determine him in the appropriate group, pursuing the following goals:
- Creation of separate cells of patients with similar symptoms and severity of the disease. This makes it possible to competently observe patients and regularly examine them, according to the approved schedule.
- Accurate monitoring of the dynamics in the process of transferring a patient from one group to another.
- Save time for the patient and the doctor with a clear distribution of specialist visits and the period of necessary treatment.
- Quick decisions when choosing treatment tactics.
- Timely appointment of various procedures and activities.
- Deregistration of patients who have overcome the disease.
- Simplicity in maintaining relevant documentation.
What is medical examination
Clinical examination helps to quickly identify sick people and assign them competent therapy. For this, special institutions have been established - TB dispensaries. Their fundamental tasks are:
- Plan for managing tuberculosis in the assigned service area.
- Development and implementation of measures aimed at preventing the development of the disease.
- Timely identification of patients.
- Formal registration of all patients, as well as people at risk.
- Dispensary observation.
- Organization of patient therapy, including outpatient chemotherapy.
What do observation groups mean?
During the medical examination, patients who develop tuberculosis can be identified, or there are substantial doubts about its absence, but the diagnosis has not yet been confirmed. In this case, people are also distributed into specific cells and conduct additional examinations or continue to be observed with unspecified genesis.
Group 0
Tuberculosis is recognized as a rather insidious disease. Dispensary registration helps doctors to fully examine a person and accurately diagnose or refute him. Group 0, for example, includes people who meet the following characteristics:
- unspecified activity of the tuberculosis process, requiring differential diagnosis;
- unclear diagnosis, requiring additional examination, which will help determine the localization of the disease and its form.
This group, in turn, is divided into subgroups:
- 0-A. It includes all patients who have not confirmed the fact of the presence of mycobacteria in the body.
- 0-B. People who need accurate diagnostics are enrolled and then assigned to the appropriate cell. Also, the group is implied for such cases when the presence of tuberculosis is in question, but at the same time there are:
- incomprehensible changes in x-rays;
- positive samples of the Mantoux reaction.
Only after a full examination of the patient is he diagnosed or completely denied the presence of tuberculosis.
Group 1
This cell includes people with an active form of the disease. Moreover, the localization of the pathology does not matter. Inside it, there is also a division:
- 1A group dispensary accounting. Tuberculosis was detected in humans for the first time.
- 1B group. Patients in whom the disease recurred.
Moreover, patients of these subgroups are also classified. This is important, because the disease can be dangerous for others, then treatment must be carried out without fail. Patients are divided as follows:
- Mycobacterium is found in urine, sputum and feces.
- Tests do not secrete mycobacteria. In this case, the patient does not observe microorganisms that would be actively released into the environment.
- Treatment was not started after the examination or was interrupted.
Group 2
According to the order of the Ministry of Education of the Russian Federation under number 109, the 2nd group of dispensary registration for tuberculosis is assigned to patients who have an active form of tuberculosis and at the same time have other chronic pathologies. The localization of the disease is not taken into account. This group is divided into separate subspecies:
- 2A. Doctors classify patients who may be cured, but this will require serious and lengthy therapy.
- 2B. Tuberculosis patients who have seriously launched their disease. Phthisiatricians warn that it is already impossible to cure such a pathology, even if you use the most powerful anti-TB methods.
Dispensary registration is designed to protect people from such a situation and help to notice the problem on time.
Group 3
The control cell includes the 3rd group of dispensary registration. Tuberculosis can be cured, but it can reappear, so these patients require special care. People included in this group can expect supportive therapy and regular check-ups.
Group 4
Persons who are constantly or often in contact with patients are assigned to the 4th group of dispensary registration for tuberculosis. This is the so-called risk group. She also has a certain classification:
- 4A. The group includes people who have contact with the patient at home or in the workplace.
- 4B. All employees of TB dispensaries and other medical facilities where tuberculosis patients are constantly located automatically fall into this group. They regularly pass the necessary tests and undergo appropriate diagnostic procedures.
It is clear that this group does not have an identified disease, but it can always become infected. Therefore, accounting for such people is very thorough and strict.
Children's dispensary registration groups
Prevention of the onset of the disease, as well as its early diagnosis in childhood, is carried out through BCG vaccination, which is still in the hospital, and the Mantoux test, which must be carried out for all children attending educational institutions. It must be understood that the risk of the disease increases significantly in contact with a sick adult.
Dispensary registration groups for tuberculosis in children are set based on the Mantoux test. If the reaction is positive, then the child is assigned to the 6th observation cell.
In this case, the group is divided into subspecies:
- 6A. This includes children who show clear signs of an incipient disease.
- 6B. They include babies who have a too obvious or active reaction to the Mantoux test.
- 6B. The group includes children who have an increased or individual sensitivity to tuberculin.
Regardless of which group of dispensary registration for tuberculosis in children was exposed, the form of the identified disease is important. If the pathology is noticed in the early stages, then it usually refers to reversible, which significantly increases the chances of a complete cure. In this case, the child can be completely removed from the dispensary.
How is the transition
Within groups, there may be shifts and movements. This can indicate both a deterioration and a positive trend. So that a person is included in the first group, it is necessary to combine a number of signs:
- Lesions of a part of a mild infiltrative nature. In this case, a decay phase should be observed and mycobacteria should be secreted.
- Examinations revealed tuberculosis of the left kidney, where mycobacteria also stand out.
The patient can be transferred to the second group if the course of the disease was unfavorable or completely absent, so the pathology took a cavernous form.
The patient can be assigned to the third group. In this case, the following symptoms should be observed:
- The disease affected the lower lobe of the right lung. The residual changes are extensive and extend far beyond the main part of the lesion.
- The right lung is struck from above. Diagnosed residual changes of not more than 3 cm in diameter.
Thus, any changes in the form of the disease and its localization entail the transfer of the patient to another dispensary group.
conclusions
All the considered groups have their own peculiarity. But before you turn on or transfer the patient from one cell to another, it is necessary to carry out a number of diagnostic measures. The division of patients into groups facilitates the work of the TB specialist and makes it possible to quickly track the dynamics of the development of pathology.