||Compliance: inducements and enforcements.
||CHEST 1979, 76, 750-756.
Laws found in almost every community make it clear
that those involved in treatment of TB not only should but must
concern themselves with patient compliance. Successful inducements
and enforcements fall into three categories: 1) Changes in the health
delivery system (example, elimination of long waiting hours, ease
of access to treatment facilities), 2) Patient / Professional relationships
- educational intervention and behaviour modification (example,
incorporating the use of prescription drugs into some part of the
patients daily routine, establishment of a long term, one-to-one
relationship between the patient and professional), 3) Direct administration
of medication. There is increased recognition and demonstration
that oral medications, when administered in above normal dosages,
also have a prolonged duration of action, leading to the formulation
of treatment regimens that allow the treatment of patients on an
out-patient basis. The estimation of cost of treatment, illustrated
for Denver city, Colorado, USA, demonstrates that when compared
to the minimum costs associated with standard regimens, the maximum
costs of a directly administered ambulatory programme are still
less. More importantly, the compliance problem is eliminated when
medications are directly administered. The use of a medication monitor
of the type suggested by Tom Moulding would permit the early detection
of potential non-compliers. DOT is successful because patients quickly
accept their part of the arrangement - freedom in exchange for co-operation.
|KEYWORDS: COMPLIANCE; USA.