Treatment of tuberculosis is more than 95 percent effective for patients who complete a course of medication as recommended by the American Thoracic Society. However, success often is not attained because of patient noncompliance which is the greatest obstacle to the successful treatment and elimination of tuberculosis. At our medical center, treatment of patients with tuberculosis has been carried out in the general outpatient clinics, often in the clinic where patients were followed up for other medical problems. In this setting, the clinic physician chose the type and duration of antituberculosis medication, the frequency of return appointments, and length of follow-up. Several problems with this treatment method recurred. Patients were not seen by the same physician at each clinic visit. Patient records were not always available. A mechanism did not exist for contacting patients who missed appointments. Patients who defaulted from treatment were not identified or referred to the Board of Health. Here
In 1982, a tuberculosis clinic was established to improve continuity of care and compliance. Since supervised outpatient chemotherapy was not possible, we established a specialized outpatient clinic. Specialized outpatient clinics have long been used for treatment of tuberculosis, but have become fewer as the prevalence of the disease and need for follow-up decreased. Recently, specialized clinics have been reinstituted as the role of noncompliance in treatment failure has been recognized. Specialized clinics for tuberculosis have emphasized strong patient relationships and successful completion of therapy. The core staff of our tuberculosis clinic was a pulmonary clinical nurse specialist and a nurse epidemiologist who followed up the patients from the time of diagnosis until completion of treatment. The clinic had a written protocol, frequent contact with the patients by the nurse specialists, and a fixed schedule of monthly clinic times.