|| Patient compliance: The most serious remaining problem
in the control of tuberculosis in the United States.
||CHEST 1979, 76, 741-743.
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 patients
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 patients
non-compliance. The authors 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.
|KEYWORDS: COMPLIANCE; USA.