a) Treatment Failure & The Problem of Non Adherence
AU : Pozsik CJ
TI : Compliance with tuberculosis therapy.
SO : MED CLIN NORTH AM 1993, 7, 1289-1301.
DT : Per
AB :

Historical evidence of non-compliance of TB patients is described to stress that non-compliance is a persistent and significant problem faced by health professionals. While there is no positive predictor of compliance, certain behavioural patterns have been identified as predicting compliance. A description of the groups exhibiting such behavioural patterns, identified from experience, are described. They include previous treatment failures, substance abusers, those with mental, emotional and physical impairments, persons comprising health workers and professionals who ought to be the most trustworthy, those who are blatantly honest (about not taking their medications even when intending to) or rebellious, persons who have failed on preventive treatment and where poor relationships have existed between the caregivers and the patients. Miscommunication because of the use of specialised technical vocabulary, cultural differences between patients and providers and institutional constraints on the forms of interaction that can take place, is a threat to any kind of personal interaction. A variety of strategies to deal with non-compliance including pill counts, urine testing for drugs or their metabolites, blood testing for the presence of anti-TB drugs and DOT are discussed. How to give DOT and problems faced in giving DOT are elaborated. Using various incentives and enablers to enhance compliance is recommended.