b) Measures to Improve Treatment Adherence
AU : Cuneo WD & Snider DE
TI : Enhancing patient compliance with tuberculosis therapy.
SO : CLINICS CHEST MED 1989, 10, 375-380.
DT : Per
AB :

The article lists the factors that influence compliance and presents, in detail, the action steps that may improve compliance with descriptions of studies to support several of the recommended actions. These action steps include: 1) Provide patient education at the time of diagnosis and periodically, throughout, treatment and follow-up, preferably in the patient’s native language, 2) Provide incentives as simple as coffee and conversation in the clinic or as complex as providing food and shelter for a homeless patient, 3) Provide appointment-keeping reminders through mail, phone calls or in pictorial form for illiterate/ low literacy patients, 4) Tailor the regimen, 5) Encourage self-monitoring, 6) Negotiate a health contract (this can be done only with those patients who have a strong, positive relationship with their providers and with those who would feel more motivated when they must depend on, or be accountable to, another person), 7) Provide supervised therapy (especially useful in the first 8 weeks of treatment), 8) Follow-up on broken appointments, 9) Provide training for health care personnel on current TB treatment regimens and on compliance-enhancing strategies. A possible solution to dealing with the major problem of patients who do not go to clinics such as the homeless is to create a cadre of urban “barefoot” doctors (former homeless, students etc.) to provide outreach services to the indigent as done by the Center for Disease Control, state and local health departments, Atlanta, Georgia, USA.