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A5565 - Adherence of Residents in Training of the University of Perpetual Help DALTA Medical Center to the 2009 International Standards for Tuberculosis Care and Their Correlation with Treatment Outcome
Author Block: R. R. Guarin1, R. M. Salonga1, J. V. Tamayo1, I. Manuel1, J. Benedicto2; 1Pulmonary Medicine, University of Perpetual Help Dalta Medical Center, Las Pinas City, Philippines, 2Pulmonary Medicine,UP-PGH, Manila, Philippines.
Rationale Tuberculosis (TB) remains a major global problem. The CDC study suggested that Philippines is one among the highest burden countries that drug-resistant TB is expected to increase over the next two decades. Physicians play a significant role in proper management of disease like TB by selecting appropriate diagnostics and treatment based on standards. The underlying principles of 2009 and 2014 International Standards for Tuberculosis Care (ISTC) have not changed. It is assumed that efforts have been made in the past to disseminate information among physicians. The investigators aim to check if they applied their learned knowledge and the correlation of their adherence with treatment outcome. Methodology A review of outpatient records of 42 indigent TB patients from January 2014 to December 2016 seen by IM residents-in-training of UPHDMC was done. Outcome variables were: (1.) The proportion of patients who received treatment based on selected ISTC cores such as Diagnosis 2 and 3, Treatment 8, 10 and 13, Addressing HIV infection and Co-morbidities 14 and 17, Public Health and Prevention 21. (2.) Patient’s treatment outcome. Results The most adhered standards were 2 (at least 2 sputum AFB), 3 (examination of specimen from extrapulmonary site) ,8 (first line treatment regimen), and 10 (monitoring treatment response), with 97.6% (41/42), 100% (4/4), 97.6% (41/42), and 92.9% (39/42) respectively. A 100% non-adherence to standard 14 (HIV) was observed. Among the 34 patients managed by IM residents and referred to TB-DOTS center, 73.5% were successfully treated, 17.6% did not comply to the said referral, 5.9% had treatment default, and 2.9% failed the treatment. Of the 8 patients managed by IM residents alone and prescribed with privately available anti-tuberculosis, 25% were successfully treated, 75% had lost to follow up after receiving the initial prescription, and 12.5% had treatment default. Conclusion IM residents-in-training of UPHDMC generally adhered to the standards for tuberculosis care specifically standards 2, 3, 8 and 10. Updates on guidelines may be provided through lectures and conferences to further reinforce adherence to standards especially on addressing co-morbidities and HIV Screening. Our study revealed that more patients were treated successfully when managed by both IM residents and TB-DOTS center. Therefore, it is recommended to refer all their TB cases to the said center and in return, the center shall provide regular feedback on new patients who complied to enroll, so that follow up may be done to patients who did not comply.