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U.S. Department of Health and Human Services

  
Education Materials > Publications > Self-Study Modules on TB > Module 9 > Case Studies

Self-Study Modules on Tuberculosis

Module 9: Patient Adherence to Tuberculosis Treatment

Answers To Case Studies

9.1. Mr. Howard is unemployed and homeless. The homeless shelter Mr. Howard frequents recently sent him to the hospital because he had TB symptoms. He was diagnosed with TB and admitted to the hospital for TB treatment. The hospital's infection control nurse immediately telephoned a TB case report to the health department TB clinic.

Mr. Howard remained in the hospital for 5 days. On the day he was discharged, a nurse instructed Mr. Howard to go to the TB clinic the following morning for an evaluation and a supply of medicine. He failed to keep the appointment.

A health care worker had been assigned to find Mr. Howard when his case was reported. When Mr. Howard missed his appointment, she set out to locate him and persuade him to come to the clinic. She eventually found him in a crowded bar, where she scolded him for his careless behavior and ordered him to return with her to the clinic.

  • What should the health care worker have done differently?

    The health care worker should have visited Mr. Howard to begin the assessment as soon as possible (before Mr. Howard left the hospital). If he had left the hospital before she got there, she should have located him and spoken to him privately. By approaching Mr. Howard in a public place, she has failed to maintain confidentiality. After approaching him in this way, the health care worker will have a difficult time establishing a trusting relationship with Mr. Howard. It is important he feel comfortable sharing his thoughts.

  • How can the health care worker get to know Mr. Howard better in order to assess potential adherence problems?

    The health care worker will need to learn as much as possible about Mr. Howard in order to assess potential adherence problems. The health care worker will need to learn the following about Mr. Howard:

    • Medical history and current health problems
    • Knowledge, beliefs, and attitudes about TB
    • Ability to take responsibility for following the TB treatment plan
    • Resources (family, other social support, finances)
    • Barriers to treatment
    • History of adherence to previous TB regimens or other medication

    Also, assessing TB patients' knowledge, beliefs, and attitudes regarding TB and adherence to TB medicine may help the health care worker better understand the patient's views and suggest areas in which the patient needs education. They may also give the health care worker some idea of the patient's ability to adhere to a treatment regimen. For example, asking a patient what problems the illness has caused him or her can help the health care worker assess the strength of family and social support; potential job-related problems; and, to some extent, the problem-solving skills of the patient.

    Throughout treatment, the health care worker should ask the patient about his or her concerns about TB and success with adherence to the regimen. Whenever possible, the health care worker should adapt such questions according to the patient's age, family situation, education level, and cultural background. Remember that the more the health care worker is aware of the patient's ideas and concerns about TB and its treatment, the better prepared the health care worker will be to anticipate and resolve problems that can arise.

9.2. Michael, 45 years old, is a cook at a local fast food restaurant. He went to see his physician because he was feeling fatigued, was unable to sleep, had lost his appetite, and had been coughing for several weeks. His physician suspected tuberculosis and admitted Michael to the hospital for further tests.

 


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination - http://www.cdc.gov/tb

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