[Development and perspectives of community DOTS].Kekkaku 2009; 84(4):187-201K
The Japanese version of DOTS seems to have established itself. However, there is criticism that the primary purpose of DOTS expansion has often been supplanted by pressure to meet a quota. In this symposium, we returned to the starting point of DOTS, i.e., seeking a total cure of TB patients, and rededicated ourselves to our ultimate goal--TB elimination. In order to promote community DOTS more effectively, we should endeavor to build a community DOTS network with unified related information systems backed by government commitments. In so doing, we must continue to provide patients with support while respecting their rights and emphasizing their improved quality of life. 1. Achievements and challenges of DOTS conference: Yukiko SAITO (Fukujuji Hospital, JATA). We conduct face-to-face DOTS for all patients from the time of their admission until the time they are discharged. The DOTS conference is a place where hospitals and public health centers can share patient information, linking hospital DOTS with community DOTS. This meeting is an indispensable process in order to prevent patients' defaulting and irregular treatment. The ultimate goal of DOTS is treatment completion of tuberculosis patients, and in order to achieve that goal, a partnership among clinical, public health, and social services is crucial. The DOTS conference provides an opportunity for several public health centers to come together and share information. Conducting hospital DOTS and the DOTS conference in parallel facilitates providing comprehensive patient support. Continuing to hold regular DOTS conferences is both a sign of achievement of DOTS and a challenge for the future. 2. Achievements and challenges of cohort meeting in the TB control program in Kobe: Noriko TANAKA (Kobe City Public Health Office) The TB control program of Kobe City is based on the Second Five-Year TB strategy targeting the reduction of the TB incidence rate. It has five policy pillars, prevention and IEC, early case-finding, standardized treatment, quality patient support, and research, which are implemented in twenty-four related activities including the cohort meeting. This meeting is held regularly and contributes greatly to the comprehensive patient care and support for their completion of regular treatment. 3. Development of TB clinical path in hospital-community health partnership--from public health centers' viewpoint: Yui ASO (Nishi Tama Public Health Center), Tomoyo NARITA (Bureau of Social Welfare and Public Health Tokyo Metropolitan Government) In order to lead all TB patients to treatment success, public health centers of the Tokyo Metropolitan Government and Tokyo Metropolitan Fuchu Hospital developed a TB clinical path (TBCP) hospital-community health partnership with the cooperation of the local medical association, the pharmacists' association, and organizations for home recuperation of elderly people. In a questionnaire, all the patients who used TBCP answered that they could take medicine themselves. It was also found that over 50% of hospital doctors and nurses, pharmacists, and public health nurses who were involved in TBCP were satisfied with good cooperation with other partners and patients' positive attitude toward their treatment. These trials revealed that the important keys to the effectiveness of TBCP include a) the shared informed consent by all the partners of the TBCP, b) timely sharing of information about patients, c) standardization of treatment and care for patients, and d) promotion of cooperation with other related players. 4. Development of TB clinical path in hospital-community health partnership--from a hospital's viewpoint: Akira FUJITA (Department of Pulmonary Medicine Tokyo Metropolitan Fuchu Hospital). Health Centers of the Tokyo Metropolitan Government, Tokyo Metropolitan Fuchu Hospital, and other organizations developed a tuberculosis clinical path in a hospital-community health partnership (TBCP). Preliminarily, we applied TBCP for 23 patients with smear-positive tuberculosis. Information-sharing by TBCP booklets between patients and health care providers will improve patients'satisfaction. The instruction for phone- and/or fax-based communication enabled healthcare providers to respond quickly in the event of variance. TBCP promoted the standardization of examinations and the actions to be taken in response to variances, as listed in the clinical path. The variance of controllable adverse effects due to anti-tuberculosis drugs was most common, having occurred 12 times. 5. Attempts of DOTS conference in the outpatient department: Yoko NAGATA (Research Institute of Tuberculosis, JATA), Kayoko MIZUKAMI, Satomi OKAWA (Daiichi Dispensary, JATA). The outpatient DOTS conference is a place where public health centers and clinics can share information on treatment and adherence support. Patient support under community DOTS targeting outpatients who do not need hospitalization requires closer cooperation between public health centers and related organizations now more than ever before. From the point of view of continuing treatment, it is thought necessary to focus on young Japanese patients, not just foreign-born patients.