||Improving compliance to chemotherapy
||PULMON 2000, 2, 27-31
Drug default is the major hurdle in the management
of TB and also the cause for relapse and treatment failure due to
drug resistance. Non-compliant patient remains infectious for a
longer period and is more likely to develop drug resistance. Non-compliance
is usually associated with complex treatment regimens involving
multiple drugs, prolonged duration of administration, confusing
dosage schedule and unacceptable route of administration. Knowledge
about disease and treatment can influence patient decision and is
essential for treatment compliance.
This study evaluates the role of better patient communication and
motivation by the provider in improving the compliance to chemotherapy
in pulmonary TB.
A randomized control trial was conducted with newly
diagnosed pulmonary TB cases in the age group 15 to 70 years attending
the chest clinic of Medical College and STC, Thiruvananthapuram,
Kerala. The study population of 530 patients was randomly allotted
to intervention (267) and control groups (263). The intervention
group was provided with daily chemotherapy, innovative communication
and motivation strategy, whereas the control group received daily
chemotherapy with usual motivation by Social Worker/Treatment Organizer.
Information provided to the patient was understandable, unbiased,
and indicated both risks & benefits. Baseline characteristics
like mean age, disease severity, and pre diagnostic cost were similar
in both the groups. Most of the default occurred in the initial
months of chemotherapy; 76% in the control and 50% in the intervention
groups occurring during the second and third months of chemotherapy.
Treatment completion rate was significantly lower in the control
group (63%) compared to intervention group (85%). Mortality rate
was 7% and 2% for control and intervention groups respectively (p
In the multivariate analysis of the study population,
age, co-morbidity, income and severity of disease did not emerge
as significant predictors of compliance. Significantly higher treatment
completion rate among the intervention group compared to the control
group indicates that to get better results, curing should be combined
with caring mode in the management of TB. The study highlights the
need for improved communication with patients to help them successfully
complete treatment without default.
|KEY WORDS: COMPLIANCE; INDIA.