'Shoe leather therapy' is gaining on TB

Article Abstract:

The use of directly observed therapy (DOT) by public health outreach workers appears to help control the tuberculosis (TB) resurgence that began in inner cities in the mid 1980s. DOT outreach workers, who watch TB patients swallow their medication, also have an important role in offering social support to TB patients who are often poor, homeless, HIV infected, or substance abusers. The spread of multidrug-resistant TB can result from incomplete drug treatment of TB patients. There are about 1200 outreach workers in the US in DOT programs funded primarily by the CDC. At the New Jersey Medical School's National Tuberculosis Center in Newark, 85% of DOT occurs in the field, and most patients in the program are treated 5 times a week for 6 months. The program witnessed an increase in treatment adherence from 69% to 92% in the first 10 months of 1995. Multidrug-resistant TB in the county fell from 6% to 1% of TB cases from 1992 to 1994. Similar promising trends were associated with programs in Baltimore and New York City.

Care and treatment, Evaluation, Tuberculosis, Public health administration, Home care services

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Taking asthma seriously

Article Abstract:

The National Heart, Lung, and Blood Institute's National Asthma Education and Prevention Program (NAEPP) has updated its 1991 guidelines for asthma treatment. The guidelines stress the use of inhaled corticosteroids and also mention leukotriene modifiers such as zafirlukast and zileuton. However, an audit of medical records and insurance claims completed in 1997 found that many asthma patients do not get their drug prescriptions filled or use the drugs incorrectly. Physicians trained under the guidelines found patient education significantly reduced emergency room use and hospitalization rates.

Usage, Drug therapy, Science and technology policy, Asthma, Practice guidelines (Medicine), United States. National Heart, Lung and Blood Institute

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