Rakesh P S, Balakrishnan Shibu, Krishnaveni V, Narayanan Vishnu, Pillai Swapna, Thomas Sumi Merin
Amrita Institute of Medical Sciences, Amrita Viswavidhyapeetham, Kochi, India.
WHO RNTCP Tecnical Assistance Project, State TB Cell, Kerala, India.
Indian J Tuberc. 2017 Apr;64(2):93-98. doi: 10.1016/j.ijtb.2016.11.007. Epub 2016 Dec 16.
The Direct Observation of Treatment (DOT) is an important component of the country's TB Control strategy. Standards of TB care in India and the End TB strategy emphasised the importance of a patient-centered approach to foster adherence. A qualitative study was conducted to explore the perception of people with Tuberculosis in Kerala regarding DOT, mechanisms to make the treatment of TB more patients centered and to identify the preferable mechanisms to ensure adherence.
Six focus group discussions were conducted - two among people with TB from rural area, two among people with TB in urban area, one among multipurpose health workers of rural area and one among key field staff of TB control in urban area.
Patients who were on a strict DOT were unhappy about the issues of confidentiality, patient inconvenience and provider centered approach. A flexible, patient centered approach were a family member can act as the DOT provider with guidance from a trained health worker was evolved as the most acceptable and comfortable mode of treatment to majority of the TB patients. They felt that a strict external monitor as a DOT provider was not a necessity in majority of the cases. Only practical way to effectively incorporate ICT in monitoring patient compliance in current scenario was identified as daily phone call reminders. Patients also expressed their concerns in keeping the medicines for entire duration at home.
A flexible patient wise individualized system based on patient's behavior, literacy and awareness along with attitude of family members is needed to ensure adherence to anti TB drugs.
直接观察治疗（DOT）是该国结核病控制策略的一个重要组成部分。印度的结核病护理标准和终结结核病策略强调了以患者为中心的方法对促进依从性的重要性。开展了一项定性研究，以探讨喀拉拉邦结核病患者对直接观察治疗的看法、使结核病治疗更以患者为中心的机制，并确定确保依从性的优选机制。
进行了六次焦点小组讨论——两次在农村地区的结核病患者中进行，两次在城市地区的结核病患者中进行，一次在农村地区的多功能卫生工作者中进行，一次在城市地区的结核病控制关键现场工作人员中进行。
接受严格直接观察治疗的患者对保密问题、给患者带来的不便以及以提供者为中心的方法感到不满。一种灵活的、以患者为中心的方法，即家庭成员可以在经过培训的卫生工作者的指导下作为直接观察治疗的提供者，逐渐成为大多数结核病患者最可接受和最舒适的治疗方式。他们认为，在大多数情况下，没有必要由严格的外部监督者作为直接观察治疗的提供者。在当前情况下，将信息通信技术有效纳入监测患者依从性的唯一实际方法被确定为每日电话提醒。患者还表达了对在家中全程保存药品的担忧。
需要一个基于患者行为、识字率、意识以及家庭成员态度的灵活的、针对患者个体的系统，以确保抗结核药物的依从性。
