ABSTRACT
To better treat and eliminate tuberculosis, patient compliance must be improved. Compliance can be evaluated by measuring a drug or its metabolite in the urine. In Arkansas, a simple colorimetric method of checking the urine for isoniazid (the Potts-Cozart test) has been used for many years, but it is relatively unknown outside that state and its reliability has not been confirmed. To evaluate this test, urine was blindly tested from patients from a tuberculosis clinic. Controls included urine from patients from a substance abuse clinic and Veterans Medical Center. In more than 200 urine samples tested, no false-positives were found. Urinalysis showed normal values for three patients who were supposed to be receiving antituberculosis medication, but it is likely that these patients were noncompliant. A peculiarity of the test was that the color change with positive tests varied. To investigate this variation, absorption spectroscopy of many substances was performed. Nicotine accounted for the different shade of blue associated with the positive test, but the color produced and the absorption spectroscopy were different from isoniazid, so it did not confuse the interpretation of the results. This test for isoniazid in the urine is simple, quick, inexpensive, easy to interpret, and reliable. It also can be used to detect nicotine and its metabolites.
Subject(s)
Isoniazid/urine , Patient Compliance , Tuberculosis, Pulmonary/drug therapy , Arkansas , Colorimetry/methods , Evaluation Studies as Topic , Humans , Indicators and Reagents , Isoniazid/therapeutic use , Nicotine/urine , Spectrum AnalysisABSTRACT
Patient compliance is the major obstacle to successful treatment of tuberculosis. To counter factors of inconstant attention to compliance, inconsistent follow-up, and incomplete documentation, a tuberculosis clinic, managed by nurse specialists, was established. To evaluate this clinic, records of all patients with tuberculosis followed-up there were compared with patients with tuberculosis observed in the other clinics over a nine-year period. Twelve percent of patients in the general clinics group had complete, documented, effective treatment compared with 86 percent in the tuberculosis clinic group. Only 31 percent of the general clinics patients compared with 100 percent of the tuberculosis clinic patients had completely documented follow-up. In hospitals in endemic areas for tuberculosis, a tuberculosis clinic may be superior to general clinics for the care of patients with tuberculosis. Staff of a specialized clinic can quickly identify a break in therapy, provide support necessary for better compliance, lessen the number of incomplete records, and decrease the number of patients who do not receive full therapy.
Subject(s)
Outpatient Clinics, Hospital/organization & administration , Patient Compliance , Tuberculosis, Pulmonary/prevention & control , Antitubercular Agents/therapeutic use , Chicago , Documentation , Drug Therapy, Combination , Female , Follow-Up Studies , Humans , Male , Medical Records , Nurse Clinicians , SpecializationABSTRACT
From July 1982 to January 1986, we saw 86 patients in the tuberculosis clinic; 77 (90%) were alcoholics; all were males, 71 (83%) were black, 14 (16%) were white, and one (1%) was hispanic. Of these, 10 patients (12%) failed to complete therapy and were referred to the Chicago Board of Health. Nine patients (10%) were dropped from the clinic: three moved from the state of Illinois, three died of nontuberculosis causes, and three were transferred to the Chest Clinic for other medical problems. Therefore, 67 patients (78%) successfully completed therapy. Our high rate of success is attributed to constant, high-intensity contact and consistent supervision of these potentially noncompliant patients.
