title: Improvement of district hospital service system to increase treatment adherence among tuberculosis patients in Pakistan.
abstract: Adherence to medication regimen is essential for tuberculosis (TB) treatment success. We carried out quasi-experimental, single group intervention study at Rawalpindi District Hospital to improve TB patient treatment adherence using a Chronic Care Model (CCM). Ninety-nine newly diagnosed TB patients at the TB Clinic, Rawalpindi District Hospital, during February-March 2009, were included in the study. A set of four quality indicators were determined based on current scientific evidence: quality of service system, patient satisfaction, treatment adherence and cure rate. Care quality changes over time were analyzed by paired t-test. Significant improvements in service quality were seen post-intervention. Overall, the hospital service system quality improved to "good" (from 1.0% to 28.3%), and patient satisfaction increased to "good" (10.2% to 54.1%). Treatment adherence increased (from 23.2% to 56.1%). The quarterly cure rate increased notably (5.3% to 17.2%). The overall mean scores for hospital service system quality, patient satisfaction, and TB patient treatment adherence, improved significantly 6 month post-intervention (p<0.001).
authors.affiliation: Department of Public Health Administration, Faculty of Public Health, Mahidol University, Faculty of Medicine Vajira Hospital, Bangkok, Thailand.
authors.forename: Muhammad Shafiq
authors.initials: MS
authors.lastname: Khan
authors.forename: Nawarat
authors.initials: N
authors.lastname: Suwannapong
authors.forename: Nopporn
authors.initials: N
authors.lastname: Howteerakul
authors.forename: Oranut
authors.initials: O
authors.lastname: Pacheun
authors.forename: Titipat
authors.initials: T
authors.lastname: Rajatanun
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003376:Counseling; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D019984:Quality Indicators, Health Care; D016896:Treatment Outcome; D014376:Tuberculosis / Q000523:psychology* / Q000628:therapy*; D055815:Young Adult