What Strategy Can be Applied to the Patients with Culture Positive Tuberculosis to Reduce Treatment Delay in a Private Tertiary Healthcare Center?

Abstract

Background: The contribution of the private sector to the treatment of tuberculosis (TB) is getting larger, and the private sector pays more attention to individualized, intensive care than patient monitoring or education, which would improve the microbiological cure rate or at least completion of treatment. We aim in this paper to assess the impact of the improved monitoring of patient on the treatment outcome in the private tertiary healthcare center. Materials and Methods: We compared the data of the positive sputum cultures for TB from March 1, 2003 to March 31, 2006 (37 months) with that data from July 1, 2007 to August 31, 2008 (14 months) in single private tertiary healthcare center in the Republic of Korea (ROK). In the latter period, we notified physicians of the new culture-confirmed cases via a cellular phone short-massage-service (SMS) to prevent delayed recognition of positive cultures and we gave calls to patients to encourage treatment adherence and to complete the whole schedule of medication. Results: After the intervention, initiation of anti-TB medication increased from 86.3% to 94.5% (P< 0.05), the interval to medication from the first culture results was shortened from 22.9 days to 5.6 days (P= 0.19) and the rate of treatment complication increased from 57.4% to 68.1% (P< 0.01). Conclusion: Our results showed a possible strategy to improve the completion of treatment in a university hospital. Health care providers in the private sector should to improve success by better notification and monitoring in addition to their existing advanced medical resources.