c) Involvement of Private Practitioners
AU : K C Mathur
TI : Tuberculosis treatment management under a private medical practitioner
SO : INDIAN J TB 2000, 47, 49-51
DT : Per
AB :

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 author’s 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.