Medicine/12. Infectious diseases.

C.m.s S.A.Yudin

Volgograd State Medical University, Russia

Treatment compliance of tubercular patients

Introduction. Tuberculosis has been declared a “global health emergency” by the WHO. The aim of tuberculosis management is to treat patients within their ordinary life style, to prevent a fatal outcome and an extensive lung involvement, disease recurrence, the rise of drug-resistant Mycobacterium tuberculosis strains and to protect family members and society from infection. [2].

A particular feature of tuberculosis management is a long term treatment achieved with improved treatment regimens and professional medical advice. In medical journal articles great attention is paid to settling this problem. [1; 5; 6; 8; 9; 10]. The World Health Organization draws attention to medical service efficacy taking into account patients’ views. [3; 7].

Materials and methods. A cohort of 584 patients receiving treatment in anti-tubercular clinics in Volgograd in 2012 from phthisiatricians and 144 district doctors filled in anonymous questionnaires in accordance with requirements of sociological studies[4].

Results and discussion. Patients’ views on following medical advice turned out to be as follows 76.5% of patients believe that they comply with medical advice; 19.9% do it in part and only 1.9% respondents stated that they didn’t follow their doctors’ advice.

Women (82.0%) showed more complete compliance with medical advice than men 74.7% (p<0.01). Patients with university education showed better compliance than school leavers 81.7% and 75.7% correspondingly (р<0.02).

Phthisiatricians expressed another opinion: 54.4% think that medical advice is complied by 50% of tubercular patients: 33.7 respondents believe that medical advice is followed by 20-30% of patients; 5.4% of doctors believe that only few people comply with medical advice; 4.3% respondents think that nearly all tubercular patients follow their doctors’ advice. 2.2% had difficulty in responding.

Physicians’ views are as follows: only 2.8% of physicians respond that nearly all tubercular patients follow their doctors’ advice; 31.3% believe that 50% of patients comply with medical advice; 33.3% respondents think that only 20-30% follow it. 24.3% pointed out that only few patients did it; 8.3 had difficulty in responding.

Thus, views of patients (76.5%), phthisiatricians (4.3%) and physicians (2.8%) believing that all patients comply with medical advice turned out to be opposite. Phthisiatricians (33.7%) and physicians’ (33.3%) views considering that every third patient and every fifth patient (19.9%) complies with medical advice coincided.

The analysis of data in questionnaires shows that patients associate the greatest difficulty in treating tuberculosis with “side – effect of medicines” (35.3%), “long term hospital stay” ( 32.3%), “negative attitude of people towards tubercular patients” (22.6%), “absence of relevant medicines” (20.5%), “presence of various systematic diseases” (19.5%) 14.1% respondents “don’t believe in recovery”. 6.5% respondents point to the “absence of relative support”. Other reasons have been reported by 4.9% respondents. 7.5% respondents had difficulty in responding. Every sixth patient (16.4%) did not experience “any particular difficulties” in treating tuberculosis.

Treatment compliance of tubercular patients is linked to patients’ satisfaction with medical advice received in anti- tubercular and district clinics. 61.3% of patients were completely satisfied with medical care in anti- tubercular clinics. 28% respondents were partly satisfied. 5/5% respondents were not satisfied and only 5% had difficulty in responding. Elderly patients (p<0.001) (male (p <0.02)) were completely satisfied with treatment. Young patients (p<0.001) (female (p<0.05)) were partly satisfied. Educational factor did not have a significant effect on the value (p>0.05).

36.5% respondents were satisfied with medical care received in district polyclinics. 30.85 were partly satisfied. 19.5 respondents were not satisfied and 13.2% had difficulty in responding. Respondents over 60 (p<0.01) were completely satisfied with medical care in policlinics but young patients (p<0.001) were partly satisfied. Gender and educational factors did not have a significant effect on the value (p>0.05).

It should be noticed that patients who were satisfied with medical care in anti – tubercular clinics turned out to be 2 times greater than in policlinics. The number of patients who were not satisfied with medical care in district polyclinics was 4 times greater than in anti – tubercular clinics. Elderly patients were completely satisfied with medical treatment both in anti – tubercular clinics and in district polyclinics compared with young patients.

Conclusion: This study highlights diametrally opposite views of doctors (phthisiatricians (4.3%) and physicians (2.8%)) and tubercular patients (76.5%) in compliance with treatment. Patients associate the greatest difficulty in treating tuberculosis with “side – effect of medicines” (35.3%), “long term hospital stay” (32.3%), “negative attitude of people towards tubercular patients” (22.6%).

Tubercular patients reported to be satisfied with medical care in anti – tubercular clinics 2 times greater than in policlinics.

A doctor – patient interaction is not effective enough. Thus, elaborating treatment compliance in tubercular patients is to be conducted with psychological follow-ups that are not widely used in phthisiology.

References.

1.Bogorodskaya E. M. Patients with tuberculosis: compliance to treatment.// Tuberculosis and lung diseases.-2009– V. 86, № 9. – p. 3–10.

2. Crofton G., Horn N., Miller Ph. Tubercular clinic/ eng.tr. — М.:Medicine, 1996. — p. 199.

3. Delarue V.V., Gorbunov A.A., Yudin S.A. Psychotherapeutic service in people evaluation// Vestnik of psychotherapy. – 2012. – № 42 (47). – p. 20–25.

4. Devyatko I.F. Methods of sociological study: Coursebook – 6-ed. М.: VCP, 2010. – 295p.

5. Naryshkina S.L., Hromova L.V., Loktorova N.P. Treatment compliance in patients with HIV. // Tuberculosis and lung diseases. – 2011. – V. 88, № 5. – p. 70.

6. Parolina L.E., Barinboym O.N., Loktorova N.P. Treatment compliance in patients with drug-resistant tuberculosis// Tuberculosis and lung diseases. – 2011. – V. 88, № 5. – p. 100–101.

7. Principles on providing quality: WHO meeting report.- Geneva,1994.- p.45.

8. Program of social support and treatment compliance of tubercular patients/ Yakubovikyan V., Bogorodskaya E. M., Borisov S.E.// Tuberculosis and lung diseases. – 2009. – V. 86, № 3. – p. 18–23.

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