The Tuberculosis Clinic: conclusion

The experience in this clinic, like that in developing countries and in recalcitrant patients, was highly successful in treating tuberculosis. In the general clinics, physicians only rarely used incorrect drug combinations. The problem was inconsistent follow-up and insufficient attention to compliance. These problems were solved more effectively at our medical center by nurse specialists than physicians. This has been reported by others in tuberculosis care. Another benefit of a specialized clinic may be saving the costs of retreatment. Although it is obvious that avoiding retreatment is important, estimation of its cost-effectiveness is difficult because it depends on the nature and infectivity of the patient with recurrence. In the tuberculosis clinic, about 9 percent of the patients were seen for repeated episodes of tuberculosis.

At the end of the study period (five years), no patient who was successfully treated in the tuberculosis clinic had relapsed. The least expensive retreatment would be for a person with mycobacteria that were sensitive to standard medication and who did not require hospitalization. With six months of three-drug therapy and six to eight clinic visits, the cost would be less than $1,000. The cost of an outpatient visit to the tuberculosis clinic is $37. For an admission for retreatment of tuberculosis, the Veterans Administration reimburses at a Diagnosis Related Group-based rate of $509 per inpatient day. An average length of stay for these patients is 15 days making the cost of retreatment $7,636. At the other extreme, Weidhaas and colleagues reported a man with resistant tuber tuberculosis clinic solved many of these problems. The tuberculosis clinic kept a separate log on each patient for instances when the medical record was unavailable. The use of a special printed progress note form improved the completeness of the record. A strong relationship developed between the nurses and the patient. The decrease in inconvenience maximized compliance. The early recognition of a break in therapy resulted in prompt action to correct a problem before the therapy failed.

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