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Problem
Statement: DOTS (Directly Observed
Treatment, Short Course) for pulmonary tuberculosis (PulTB) is a major
strategy in the Thai National Tuberculosis Program (NTP) following the
World Health Organization (WHO) global plan. Thailand was ranked 16th
of 22 high-burden countries in 2002 in the WHO global tuberculosis
control report. Community pharmacists are part of the health care team
that should play a role in improving outcomes in pulmonary
tuberculosis outpatients.
Objectives:
To compare clinical outcomes between
community pharmacists monitoring patients and control patients
receiving normal care.
Design:
Quasi experimental study design.
Setting and
Population: Eighty pulmonary tuberculosis
outpatients without HIV co-infection were treated with DOTS category 1
(2HRZE+4HR) between December 2002 and January 2004 at Mahasarakham
provincial hospital. Patients who were diagnosed with PulTB and had
completed the intensive treatment phase (2rd month with sputum
converted to negative) volunteered to be monitored and receive
medications from pharmacists at a University pharmacy. This was the
treatment group. Patients who wanted to be monitored only from the
hospital were the control group.
Intervention:
Pharmaceutical care by pharmacists and
refill of DOTS medications. The non-intervention group received care
from the hospital.
Outcome
Measures: Clinical outcomes were assessed
when the patients completed DOTS (6 months). Following the WHO
tuberculosis treatment definition, outcomes were cure rate (sputum
conversion at month 6); treatment success rate (summation of cure and
completion rate); default rate (lost more than 2 months); and failure
rate (positive sputum test at month 6).
Results:
Fifty-four PulTB patients who completed DOTS during
the preliminary study period (December 2002 to October 2003) were male
(61.80%), age 52.69 + 15.58 years. There were 27 eligible patients in
both the pharmacist-monitored group and the control group.There were
no significant differences between groups with respect to age and
gender (p = 0.495, 0.573, respectively). Smear positive patients in
the pharmacist- monitored group were 62.96% and 44.44% in the control
group. Smear positive cases showed a cure rate of 94.12% for the
treatment group and 66.67% for the control group. Treatment success
rate in the treatment group was 96.23% and 74.10% in the control group
(p = 0.022). Default rate in the control group was 22.22% (6 cases)
and in treatment group was 3.7% (1 case, p = 0.043). The control group
had one failure but there were none in the treatment group.
Conclusions:
Community pharmacist monitoring can improve
the treatment success rate to achieve the WHO goal (more than 85%) and
decrease default and failure rates. The results show that community
pharmacists involvement in a DOTS multidisciplinary team improved
clinical outcomes in pulmonary tuberculosis outpatients. |