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American Journal of Respiratory and Critical Care Medicine Vol 172. pp. 140, (2005)
© 2005 American Thoracic Society

Correspondence

And The Beat Goes On

From the Authors:

We appreciate the comments of Drs. Reichman and Mangura regarding our study of directly observed therapy (DOT) for tuberculosis patients in San Francisco (1). As we stated in our Methods section, DOT in our study involved more than simply observing patients taking their antituberculosis medications. Patients received so-called enhanced DOT in which enablers and incentives such as travel vouchers, food, and housing assistance were utilized to promote adherence (2). While enablers and incentives enhance completion of treatment, it cannot be overstated that successful tuberculosis care requires establishing trust and credibility with each patient. Necessary components include staff commitment as well as a respectful, tolerant, and compassionate approach. Experience and skill in working with patients who are marginalized or from different cultures are also important in addressing individual psychosocial needs.

We agree that this individualized focus on a patient's specific needs, referred to as "case management" by Dr. Reichman, is critical for the success that we found in our DOT program. A patient-centered approach based on each patient's specific social circumstances is an integral component of DOT.

Robert M. Jasmer, L. Masae Kawamura and Charles L. Daley

San Francisco General Hospital and Tuberculosis Control Section, San Francisco Department of Public Health, San Francisco, California

FOOTNOTES

Conflict of Interest Statement: R.M.J. does not have a financial relationship with a commercial entity that has an interest in the subject of this manuscript; L.M.K. does not have a financial relationship with a commercial entity that has an interest in the subject of this manuscript; C.L.D. does not have a financial relationship with a commercial entity that has an interest in the subject of this manuscript.

REFERENCES

  1. Jasmer RM, Seaman CB, Gonzalez LC, Kawamura LM, Osmond DH, Daley CL. Tuberculosis treatment outcomes: directly observed therapy compared with self-administered therapy. Am J Respir Crit Care Med 2004;170:561–566.[Abstract/Free Full Text]
  2. American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America. Treatment of tuberculosis. Am J Respir Crit Care Med 2003;167:603–662.[Free Full Text]




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HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Proc. Am. Thorac. Soc. Am. J. Respir. Cell Mol. Biol.
Copyright © 2005 American Thoracic Society