b) Measures to Improve Treatment Adherence
AU : Sbarbaro JA
TI : Compliance: inducements and enforcements.
SO : CHEST 1979, 76, 750-756.
DT : Per
AB :

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 patient’s 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.