Adherence is associated with the quality of professional-patient interaction in Directly Observed Treatment Short-course, DOTS

Pranaya Mishra, Ebba Holme Hansen, Svend Sabroe, Kumud Kumar Kafle
Patient Education and Counseling 2006, 63 (1): 29-37

OBJECTIVE: To investigate the association between the behaviour of health professionals as reported by patients, the quality of communication, patients' communication about their disease, and non-adherence to Directly Observed Tuberculosis Treatment Short-course, DOTS.

METHODS: This study was designed as a case-control study based on 50 cases (non-adherents) and 100 controls (adherents), conducted in a hilly western district in Nepal. The participation rate was 80% for 50 cases and 95% for 100 controls. All covariates with p-value<or=0.2 were included in a multivariate logistic regression model to identify the factors significantly associated with treatment non-adherence.

RESULTS: The analysis identified that poor-grade communication (OR=11.2; CI 2.5-50.4) and fair-grade communication (OR=2.7; CI 1.2-6.3) between patients and dispensers were significantly associated with non-adherence.

CONCLUSION: Better communication between health professionals, particularly dispensers, and patients is essential for improving treatment adherence in TB treatment, even under DOTS.

PRACTICE IMPLICATIONS: Drug dispensers should be trained to develop their communication skills about the use of medications, associated side effects, benefits and risk of non-adherence, as well as to respect the individual patient's autonomy and integrity.

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