The patients were evaluated initially by a pulmonary fellow and the clinic attending pulmonary physician and thereafter monthly by the same nurse specialist. The pulmonologist saw all patients to start, stop or change therapy, to review radiographs and abnormal clinical data and to evaluate other medical problems. Documentation was standardized by use of printed progress notes. Patients who missed their appointments were called that day and rescheduled for the following clinic day. All patients who refused treatment or who defaulted were promptly referred to the Board of Health for follow-up.
The main method of increasing compliance was to establish a strong alliance between the patient and the health care team. To develop the relationship, we sought to understand the patients attitude and belief about tuberculosis. We obtained a verbal commitment from the patient to complete therapy. Patients were encouraged to accept their diagnosis and given information about their progress at each clinic visit, which included viewing their radiographs with them. We used several strategies to make the clinic visit a satisfying experience. First, waiting time was reduced by scheduling appointments. Personal expense was reduced by providing money for public transportation. Telephone calls were made the day before to remind patients of the clinic appointment. Social, economic and other medical problems were referred within the system. Last, simple drug schedules that used rifampin and isoniazid combination capsules were prescribed. The relationships that were established facilitated the goal of successfully completing treatment for all patients with tuberculosis. In this report, we compare the treatment and follow-up of outpatients with tuberculosis in the general clinics with treatment and follow-up of the tuberculosis clinic patients in the four years before and the five years after the establishment of the clinic.