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Journal of Public Health

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01-04-2016 | Original Article

Disconnecting the DOTS: misconceptions about the therapeutic paradigm of tuberculosis patients at family healthcare centers in Istanbul

Authors: Yesim Yasin, Selma Karabey

Published in: Journal of Public Health | Issue 2/2016

Abstract

Purpose

There has been a major transformation in the Turkish healthcare system since 2003. The new paradigm introduced the family medicine model, which profoundly changed the structure of primary healthcare access and delivery. In the context of tuberculosis (TB) control, it led to transferring the responsibility for directly observed therapy (DOT) from anti-TB clinics to family healthcare centers. This change entailed daily interaction of the health staff of family healthcare centers with TB patients who had been treated solely in anti-TB clinics under the vertical system since the 1940s. These encounters resulted in erroneous DOT practices and inappropriate treatment of TB patients. In this study, we attempt to question the ways in which TB control has so far been and will possibly be affected by this change.

Methods

We collected our data through semi-structured, in-depth interviews with ten family physicians, ten nurses/midwives and ten TB experts in Istanbul between January and December 2012.

Results

Our interviews revealed that family physicians predominantly think that they are not well equipped to deal with TB patients in terms of infrastructure and time. Besides, it seems that most of them have misconceptions about DOT and the transmission route of TB.

Conclusion

Our research points out that the aim and rationale of DOT should be clarified for the healthcare staff of family healthcare centers. We also assume that if an inappropriate approach toward TB patients in primary healthcare settings prevails, this will negatively affect the help-seeking behavior of TB patients and hence the treatment success in the long run.

The incidence and prevalence rates were 58/100,000 and 51/100,000, respectively, whereas it dropped to 28/100,000 for the former and 24/100,000 for the latter in 2010. The mortality rate decreased from 7 per 100,000 in 1990 to 3 per 100,000 in 2010 (Yildirim et al. 2013).

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Title: Disconnecting the DOTS: misconceptions about the therapeutic paradigm of tuberculosis patients at family healthcare centers in Istanbul
Authors: Yesim Yasin
Selma Karabey
Publication date: 01-04-2016
Publisher: Springer Berlin Heidelberg
Published in: Journal of Public Health / Issue 2/2016
Print ISSN: 2198-1833
Electronic ISSN: 1613-2238
DOI: https://doi.org/10.1007/s10389-016-0708-9

At a glance: The STEP trials

Springer Medicine

Disconnecting the DOTS: misconceptions about the therapeutic paradigm of tuberculosis patients at family healthcare centers in Istanbul

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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