A new study by SingHealth Polyclinics sheds light on why tuberculosis patients dislike their strict treatment regime and how healthcare workers can help them stick with it.
Tuberculosis – what you need to know
After a past decline in cases of
tuberculosis (TB) in Singapore, there has been a recent resurgence.
Tuberculosis is an airborne disease transmitted through fine respiratory droplets from an infected person. It usually affects the lungs, but other areas – the brain, lymph nodes, kidneys, bones and joints – can also be affected.
Following the launch of the Singapore Tuberculosis Elimination Programme (Step) in 1997, the incidence of TB declined to 35 per 100,000 resident population in 2007.
Patients with TB are most likely to spread it to people they have close and prolonged contact with.
cannot get TB from:
- sharing drinking containers
- eating utensils or cigarettes
- saliva shared from kissing
- sharing of food
- touching bed linen or toilet seats
Tuberculosis treatment – Directly Observed Therapy (DOT)
Patients with tuberculosis (TB) must be treated for six to nine months under strict supervision – not only for their own recovery but also to stop them spreading the disease to others.
Called Directly Observed Therapy (DOT), the treatment requires patients to go to a clinic daily or three times a week and take their medicine (about 11 tablets initially) in front of a health care worker, most often a nurse. The process is rather quick. The patient registers, heads for the treatment room, downs the medicine and leaves. The treatment is advocated by the World Health Organization as standard care for patients, as well as a means to curb the spread of the disease.
Patient survey result findings for DOT
As the strict regime affects life and work, SingHealth Polyclinics (SHP) did a survey on its socio-economic burden on patients. The survey involved 356 patients aged 21 to 83. About 70 per cent had to go for the treatment daily, and the rest thrice-weekly. The results showed that most patients accepted the DOT regime for TB treatment in a polyclinic, including the extra time incurred.
About half said their quality of life was good or very good, and an almost equal number were satisfied with their health during DOT. However, a quarter felt the weight of socio-economic issues. Patients pointed out disruptions to their daily lives – work, school and social activities. Some reduced their social interactions because they thought friends or loved ones would not accept them.
Although work was disrupted, 77 per cent did not feel their career opportunities were affected, but 21 per cent felt their employers were disgruntled by these disruptions.
Dr Tan Ngiap Chuan, Senior Consultant and Family Physician, and Director (Research),
SingHealth Polyclinics (SHP), a member of the
SingHealth group, said: “This is the first time that we’ve got data on the proportion of people who feel negative about the treatment. Now that we’re aware, we can put in efforts to help them complete the treatment.”
He said that sometimes patients just need someone to listen and then they feel better, but they should not feel a stigma from having to follow the regime. “We should help them because if they recover, it’s for everybody’s good. Our role as primary health care professionals is to support and help them complete the treatment for their own sakes, and for their families, colleagues and the community.”
Ms Stephanie Teo, Chief Nurse, Department of Nursing, SHP, said it is often harder at the beginning to get patients to open up, because they are still trying to adjust to the treatment regime. “But after that, most will build a rapport with our nurses, and from there, they provide a bit more information. If patients tell us about their financial difficulties, we can refer them to a social worker.”
Ms Lee Hwee Khim, Nurse Clinician, SHP - Outram, the study’s lead author, said: “We’ve shared the findings with polyclinic supervisors, who will encourage nurses to approach patients to see if they are facing financial difficulties. This way, nurses can interact with patients to help the most vulnerable.”
Survey results at a glance:
How they viewed the regime:
- 74% felt despair, anxiety and depression.
- 72% accepted the regime as treatment progressed.
- 52% said their quality of life was good or very good
- 47% were satisfied with their health
How it affected them:
- 74% experienced despair, anxiety and depression
- 52% said their quality of life remained good or very good
- 63% said it affected their daily life
- 45% said it disrupted work, school and social activities
- 47% reduced their social functions because some perceived they wouldn’t be accepted by friends or loved ones.
How it affected their jobs:
- 77% said DOT did not negatively affect their career opportunities
- 21% felt that employers were disgruntled because it disrupted their work schedules and duties
How much it cost them:
- 53% incurred more expenses during DOT
- 73% reported increased travel time (average of 41 minutes per DOT visit)
Estimated average transport cost per visit was $1.80; mean expenditure was $260 and $389 for six to nine months if a patient travelled to the polyclinic six days per week.