In Japan, the interval between the occurrence of symptoms and the first contact with a health care provider was 17 days, but this varied remarkably between individual patients. Patient's was also influenced by profession and location of residence. In remote areas, motivation of patient himself and/or of family members or close friend for early visit to health facilities is needed. Patient's delay of the educated people and that of not educated people were not so different with each other. Health education for health care providers is much more important than that for people in the community. Health care providers must also find out the local beliefs about TB, so that education about TB and its treatment can be adapted to those beliefs. Religion, caste, bribe or degree of education may influence people ideas. If traditional healers are existed in remote areas, health care providers should persuade and educate them to send patients with possible TB to health facilities for diagnosis and treatment.
V. Conclusions
In numerous studies, those in Kenya, India, Nepal and Japan, it has been demonstrated that the problem of delay between onset of symptoms and initiation of appropriate treatment lies less with the patient than with the medical system. If cure cannot be guaranteed for a large majority of patients, expanding case finding activities does not make sense. There is little doubt that passive case finding coupled with efficient treatment is the most rewarding activity in TB control. In both low-income and high-income countries, the problem of delay in diagnosis does not so much lie with the patient's failure to seek medical attention as with the failure of the medical system to properly and rapidly diagnose TB. In low-income countries, tremendous efforts need to be make to improve the cure of patients, to expand the primary health care system, and to educate health care providers to react appropriately to patients who complain about prolonged respiratory tract symptoms (for example, a cough for more than 3 weeks).
Improvement of patient adherence to treatment
Hidenori MASUYAMA, M.D.,Dai-ich Dispensary, JATA
Tuberculosis (TB), a contagious disease that frequently affects the lungs, has returned as a public health threat in developed countries, and has still been a heavy burden on developing countries. TB is nearly always curable if patients are given a complete and uninterrupted course of drug therapy and if they take these medications as prescribed. However, poor adherence to TB medication regimens is a common problem and leads to inadequate treatment. The consequences of inadequate and incomplete TB treatment are serious and as follows:
1. Prolonged illness and disability for the patient
2. Infectiousness of the patient, causing continued transmission of TB in the community.
3. Development of drug-resistant TB
4. The possibility of death
In general, adherence to medical treatment depends on the characteristics of the treatment, the characteristics of the health care delivery system, and the patient/health care provider bond. The characteristics of TB treatment that can cause a decrease in adherence include its length, the need to take several medications, and the cost of treatment. In order to maximize the chance that patients with TB complete treatment, programmes of directly observed therapy (DOT) have been developed. These programmes usually include the trained health care provider to observe a patient take every dose of medications, the offering of such incentives as cash, transportation tokens, food and shelter, and practices that actively attempt to reduce barriers to completion. Such practices include limiting patient waiting times, using appointment reminders, having all services provided in one setting, expanding the availability of services to evenings and weekends, not changing for medications, and providing access to social services such as housing and alcohol and drug counseling.
