KINCADE, G. F.
Canadian Medical Association Journal
To most workers in undeveloped countries domiciliary treatment of tuberculosis is one of the most important aspects of the campaign against that disease. However, this article adds little to our knowledge in this connexion and offers little in the way of advice to such workers, as it is almost entirely devoted to treatment in much more sophisticated circumstances than are usually met with overseas. Trends in Canada show that since 1954 the average length of stay in sanatoria has been reduced by about 40%. Although most Canadian provinces recommend admission for patients with active tuberculosis, certain provinces, such as British Columbia, only treat a proportion of such patients in sanatoria, and 30%, of all patients with new active disease are treated entirely by domiciliary care. In Ontario 12% are so treated. However, "the preponderance of cases so treated are minimal and noninfectious." The patients chosen for out-patient therapy are carefully investigated before the decision is made, and apart from any other consideration availability of local health services and tuberculosis clinics through which close supervision can be exercised and drugs distributed is a determining factor. Patients from remote areas where control and supervision are not so readily available must be treated initially in sanatoria.
The length of treatment is of some interest. In Ontario in 1961 only 43%. of patients with far advanced tuberculosis received chemotherapy for 24 months or more, but since then the proportion has now risen to 71%. Similarly 51% of patients with moderately advanced disease now receive treatment for more than 24 months, whereas in 1961 only 29% did.
From surveys it appeared that 85% of out-patients took their drugs consistently. Formal studies in Canada are few, but clinical impressions suggest that the results are as good as when patients spend much longer periods in sanatoria. The acceptance of domiciliary treatment has of course brought into sharper focus the need for an improved and expanded tuberculosis clinic service, and for the closer supervision of patients outside sanatoria.
The chief factors favouring sanatorium treatment are said to be: -(1) Control of infection by the removal of the source from contacts. (2) Better investigation of the patient. (3) Proper selection of an adequate combination of drugs. (4) Rest and restriction of activities. (5) Health education.
The chief factors against sanatorium treatment are: -(1) Destruction of the family unit. (2) The creation of economic difficulties. (3) The cost of sanatorium care versus home care.
In respect of sanatorium treatment many believe that the control of infection is overstressed, that while it. can be shown that many patients are excreting tubercle bacilli, these patients do not necessarily spread disease.
In British Columbia 1 review showed that the average period of conversion from sputum positive to sputum negative was only 62 days from the beginning of treatment.
The advantages: of sanatorium treatment are often outweighed by the economic difficulties created by the patient's withdrawal from his job, and the crisis developing in families. Although more emphasis should be placed on the financial savings related to the shortening of sanatorium stay it would be of more value if the funds thus saved could be directed towards the expansion of clinic facilities. Apparently there will always be a need for a certain number of sanatoria and some patients will be treated in sanatoria; the steadily increasing need for beds for other conditions, the aged for instance, must also be recognized, and therefore the need to extend domiciliary treatment wherever possible must be a matter for active consideration. No details are given of such domiciliary clinics, or established staffs, or how they function, but it would appear that they are staffed by well-trained and well-selected personnel. J. S. Meredith.
Record Number :
Language of text :
Language of summary :
Indexing terms for this abstract:
Organism descriptor(s) :
man, Mycobacterium tuberculosis
campaigns, control methods, drug therapy, economics, education, health care, health centres, health education, health services, infection control, infections, patients, personnel, sputum, surveys, therapy, tuberculosis, workers
bacterium, chemotherapy, employees, health centers, staff, therapeutics
Geographical Location(s) :
British Columbia, Canada, North America, Ontario
Broader term(s) :
Homo, Hominidae, primates, mammals, vertebrates, Chordata, animals, eukaryotes, Mycobacterium, Mycobacteriaceae, Corynebacterineae, Actinomycetales, Actinobacteridae, Actinobacteria, Bacteria, prokaryotes, Canada, APEC countries, Commonwealth of Nations, Developed Countries, North America, America, OECD Countries