The Tuberculosis Clinic: Discussion

The Tuberculosis Clinic: DiscussionThis study was an attempt to compare the compliance aspects of the treatment and care of patients with tuberculosis in a specialty clinic with their treatment and care in general clinics in a teaching hospital. Although not a randomized prospective trial we felt there may be important lessons for those caring for patients with tuberculosis. We anticipated that more outpatients from the tuberculosis clinic than from the general clinics would have documentation of successful treatment, but we were surprised to learn that more than half (64 percent) of the records of the general clinics were incomplete. Most records showed neither the Start and stop dates of the medications nor evidence of compliance. The content of the progress notes varied with physicians and clinics. Failed appointments were frequent. Laboratory reports of sputum growth of M tuberculosis went unnoticed. The notation “chart unavailable” frequently appeared in the progress note, making it difficult for physicians to document progress.

Yet, these problems are not unique to our institution, as other teaching hospitals have reported similar problems in tuberculosis care. Changes in resident physicians make the continuity of care in general clinics difficult. Many causes of noncompliance were identified. Some patients could not tolerate waiting. Others had a low regard for their health. Some patients stated that they did not know they were supposed to be treated for tuberculosis after hospital discharge, despite documentation in the hospital record of patient education.
With its organization and singleness of purpose, the culosis who infected a large number of others. For this missed case, the cost to the state of Massachusetts was well over a million dollars. This study suggests a major part of the noncompliance problem rests with the health care team. If patients are being “lost,” a specialized clinic with intensive efforts on compliance and follow-up may be effective in increasing the success of treatment and eradication of tuberculosis.


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