a) Treatment Failure & The Problem of Non Adherence
AU : Addington WW
TI : Patient compliance: The most serious remaining problem in the control of tuberculosis in the United States.
SO : CHEST 1979, 76, 741-743.
DT : Per
AB :

In the United States, failure to comply with appropriate anti-TB chemotherapy is the most serious remaining barrier to the control of TB. Studies on patient compliance can be separated into a number of categories, yet, very little exists that is useful in overcoming the problem of non-compliance. A health belief model (Becker 1974) has been developed that contains the patient’s perception of susceptibility to and severity of his/her illness and, the costs and benefits of the recommended treatment. It was found that patients often report that they stop taking their medicine as soon as they feel better, a crucial phenomenon in the patient’s non-compliance. The author’s perception was that non-compliance represented self-destructive forces in the patient that were poorly understood by both the patient and the health care provider. Examples of such destruction were evident even within the health belief model. Data from reports on TB patients who completed their chemotherapy, received within 24 months by the Center for Disease Control, USA, revealed that approximately 23-31% of newly-diagnosed TB patients did not complete their chemotherapy within 24 months and, this result extrapolated for all patients in the US, led to an estimated 7,130 - 11,512 non-completers for the years 1970-1975.

Experience at Cook County Hospital in Chicago for 5 years is discussed in detail. The study, here, concluded that directly supervised chemotherapy was the only possible solution to poor compliance in inner city TB programmes. Organising the supervision of therapy was more crucial than the type of regimen chosen. It was suggested that the cost of such initial therapy would be less as multiple hospitalizations and treatment failures could be prevented.