Role of pharmaceutical care for self-administered pulmonary tuberculosis treatment in Thailand.
OBJECTIVE
With resource constraints in Thailand, directly observed therapy (DOT) for treating tuberculosis (TB) may not be feasible to implement. To improve patients' adherence, hospitals either modify DOT or adopt different approaches: pharmaceutical care or home visit. Our objective was to assess pulmonary TB treatment success rate of pharmaceutical care compared to home visit and modified DOT in Thailand.


METHODS
We conducted a retrospective cohort study using data collected in adult pulmonary TB patients starting treatment between October 2010 and September 2013 in three hospitals in Thailand. This study was approved by the Research Ethics Board at each of the participating hospitals. We built a propensity score matching to account for differences in patient baseline characteristics.


RESULTS
Analysis included 1398 patients. Before matching, the treatment success rate for patients receiving pharmaceutical care was 94.9%, home visit 93.6% and modified DOT 90.1%. The propensity score-matched cohorts indicated that differences in the treatment success rate were not statistically significant when comparing pharmaceutical care with either home visit (success rate: 92.76% vs 94.74%, risk difference: 1.97%, 95% CI -3.64 to 7.59) or modified DOT (success rate 93.37% for both, risk difference: 0%, 95% CI -5.30 to 5.30).


CONCLUSIONS
Pharmaceutical care, home visit and modified DOT are all associated with high success rate for pulmonary TB treatment and exceeded the WHO target, in this retrospective analysis.
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.|Department of Pharmacy Administration, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hatyai, Songkhla, Thailand.
P
P
Tanvejsilp
Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada.
E
E
Pullenayegum
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.|Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.
M
M
Loeb
Department of Biology, McMaster University, Hamilton, ON, Canada.
J
J
Dushoff
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.|Program for Health Economics and Outcome Measures (PHENOM), Hamilton, ON, Canada.|Centre for Evaluation of Medicines, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
F
F
Xie
D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D023801:Directly Observed Therapy / Q000379:methods*; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010593:Pharmaceutical Services / Q000458:organization & administration*; D012189:Retrospective Studies; D012646:Self Administration; D013785:Thailand; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy*; D055815:Young Adult
D000995:Antitubercular Agents
adherence; patient education; pharmaceutical care; pulmonary tuberculosis; self-administered therapy