Enlisting co-operation of TB patients in adhering
to the prescribed drug regimen, dosages, regularity of drug intake
and completion of treatment, under the condition of a private medical
practice in India is of topical interest.
It is a common belief that private medical practitioners
do not take adequate efforts to offer organized medical care to
TB cases due to various reasons. The study was undertaken by a private
medical practitioner himself to highlight the TB treatment management
under a private medical practitioner. Of the study cohort of 307,
20-25% were from Bikaner city, another 25-30% from Bikaner district,
rest were from neighboring districts. Of the total patients, 211
comprised of newly diagnosed and 96 of previously treated patients.
They were all registered at the authors private clinic from
1st Oct 1991 to 31st Dec 1995.
The SCC regimen chosen was 2EHRZ/4HER/3HR and self-administered
at home. The regimen and the frequency of monitoring check up in
the present study are somewhat different from those recommended
under the NTCP. Around 20% of the expected irregularity in drug
intake was sought to be covered by prolonging the treatment period
from 6 months to 9 months so that each case has the best chance
of completing at least 7 months treatment in 9 months. Great care
was taken that patients take at least 3 drugs in the initial phase
of 2 months.
Personal motivation was given by the private practitioner
to the patient and/or family members at each visit and monthly visits
which helped the practitioner to maintain a good level of health
education and establishing motivational support with patients.
Patient co-operation during the study was quite
satisfactory. More than 2/3 of the patients were regular in coming
to the clinic. As told by the patients at the time of follow up
visits, upto 80% had taken their treatment regularly for 7 months
or more in 9 months. There was hardly any difference between the
newly diagnosed and previously treated patients in this regard.
Of the 307 patients in the cohort 244 (80%) were available for assessing
the efficacy of treatment at the end of 9 months. The bacteriological
conversion among those previously treated and newly diagnosed was
85% and 90% respectively.
This study demonstrates that a Private Medical
Practitioner with minimum infrastructure too can provide anti-TB
drug delivery and regular motivation at clinic without difficulty.
Therefore, satisfactory results obtained comparable to any good
public sector control programme are due to good services provided
by the practitioner. Adherence to treatment was the same in both
previously treated and untreated cases which suggests that if a
reasonable care is provided, the previous poor experience is no
bar to enlist co-operation to get good results.