||Compliance with tuberculosis therapy.
||MED CLIN NORTH AM 1993, 7, 1289-1301.
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.
|KEYWORDS: COMPLIANCE; USA.