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The DH action plan for tuberculosis, states that patients should be supported in taking their medication if required. It is important that nursing staff understand why patients do not adhere to treatment regimes and also the possible implications of non-adherence.
Several pieces of research have been undertaken on the subject of adherence and how non-adherence could be addressed.
McDonnell undertook a correlation study identifying antecedents of adherence in tuberculosis medication. The researchers found that a major contributor to tuberculosis re-emerging in the United States was a combination has also been cited for UK's rising cases.
The study concluded that as adherence to tuberculosis medication can depend on a number of factors including perceptions; the nurses that caring for these patients must have an awareness of the complexities of anti-adherence behaviors. This would then enable high-risk patients to be identified and interventions set out at an early stage.
There are a number of consequences that can result from non-adherence; Griffith and Tengnah undertook a case study which found that non-adherence to tuberculosis treatment had resulted in the disease spreading to other members of a communitie. Bell has also started that projecting communities from the cross infection of tuberculosis is the major challenge presented when patients do not adhere to their medication. Griffith and Tengnah also found that failing to adhere to the treatment can result in multi-drug-resistant tuberculosis(MDR-TB) which is fatal in 50% of all cases. These deaths could therefore be avoided by patients completing their treatment.
Dick suggest that medication adherence is a very complex issue in tuberculosis care. In their study they identified that she emphasis in tuberculosis care tends to be about treatment rather than looking at how the patient is feeling. As the treatment can take 6-8 months an ideal situation would be that the patient is looked at holistically. Chalco identified that district nurses are known to be a major source of emotional support for patients and their families during illness and highlights the key role of emotional support in terms of patients adhering to treatment, although this has not been done in relation to patients with infectious diseases. The study points out that district nurses are unique in that they not only deal with the patient but also their families and in some respects communities as a whole. Hairon also said that owing to the contract that nurses have with patients they have a crucial role to play in adherence.
Scullion states that tuberculosis requires prompt treatment and compliance by the patient. The author suggests that adherence can be improved by monitoring the patient on a monthly basis. The author does not say how this would improve adherence. It could be presumed that non-adherence would be identified early and could be acted upon. Scullion also states that all nurses need to be aware of the possibility of their patients contracting tuberculosis. Therefore tuberculosis is everyone's business and not just that tuberculosis specialist nurses.
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