Abstract
TB drug default severely affects new pulmonary TB patients. It causes TB drug resistance, more difficult, and higher cost of treatment. This study aimed to develop a system to prevent TB drug default among new pulmonary TB cases. It is carried out in collaboration with eighty-four multidisciplinary personnel of fifteen tertiary care hospitals from all regions by applying the collaborative quality improvement concept of The Institute for Healthcare Improvement [IHI], USA, and the system development process. The developed system was implemented for caring for new pulmonary TB patients in the participating hospitals The effectiveness of the system was evaluated by comparing the drug default rate of new pulmonary TB patients before and after hospitals participated in the project and determining personnel opinions on the developed system using self-administered questionnaires and in-depth interviews. A developed system for the prevention of TB drug default among new pulmonary TB patients consists of important operations: 1) the establishment of a hospital TB team, consisting of a physician or pulmonologist (Mr. TB), a social medicine nurse, or a TB clinic nurse (TB manager or coordinator), a pharmacist, a medical technologist, a social worker, a nutritionist, and an epidemiologist. 2) Patient treatment rights management, 3) Screening of patients at risk of drug default, 4) Counseling and support, and 5) Monitoring and referral system. The evaluation of the effectiveness of the TB drug-default prevention system revealed that the drug default rate of 92.86% of participating hospitals in 2023 decreased when compared to the default rate between 2018-2022. Two hospitals did not find any TB drug default cases. Sixty-two percent of participating hospital personnel (52/84 personnel) answered the questionnaire on their opinion toward the developed system. 80.77% strongly agreed that the system was beneficial for patients and their families. 73.08 % and 71.15 % strongly agreed that it could be disseminated to other hospitals and could be used to care for new pulmonary TB patients appropriately and effectively. It helps reduce the rate of drug default. Based on in-depth interviews with 29 personnel, they agreed that having a new TB care system that covers the activities that hospitals undertake contributed to more efficient TB care. TB clinics and related departments within the hospital have clear operational guidelines. It is very beneficial for new personnel. However, to develop a more effective system for preventing TB drug default, the implementation of the developed prevention system should be evaluated periodically in each hospital. There should be sufficient and full-time multidisciplinary personnel at TB clinics. Media should be developed for educating each new TB patient group and promote TB clinics to have a truly standardized facility as a One Stop Service.
