||Cuneo WD & Snider DE
||Enhancing patient compliance with tuberculosis therapy.
||CLINICS CHEST MED 1989, 10, 375-380.
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 patients 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.
|KEYWORDS: COMPLIANCE; USA.