PHYSICIAN COMPLIANCE WITH NATIONAL TUBERCULOSIS TREATMENT GUIDELINES - A UNIVERSITY HOSPITAL STUDY

SETTING: The Aga Khan University Hospital, in Karachi, Pakistan, is a 650-bed university teaching hospital. OBJECTIVES: There is little data from Pakistan on the awareness and application of the World Health Or ganisation (WHO)'s tuberculosis treatment guidelines among physicians. This study evaluates physician compliance with these guidelines. DESI GN: A questionnaire to measure physician compliance was developed, pil ot tested and standardised. Case records of all patients hospitalized with tuberculosis were reviewed (January-December 1995, n = 229), and were classified into WHO Category 1 (n = 191), Category 2 (n = 9) and Category 3 (n = 29). RESULTS: A total of 53 (23%) patients had a diagn ostic bacteriological sputum smear examination, of which 38% were smea r positive and 47% culture positive. Of 25 cerebrospinal fluid culture s 12% were positive. No sputum smear tests were conducted during treat ment. Of 58 patients in Category 1 who completed therapy 74% received a 2-month intensive phase consisting of HRZE (isoniazid, rifampicin, p yrazinamide, ethambutol) (n = 43), while 41% received a 6 month contin uation phase with HE (n = 24). Over 70% patients were lost to follow u p, more than half of these during the intensive phase. CONCLUSION: Our study reflects poor awareness of the WHO guidelines and low complianc e among physicians, and a high loss to follow-up. Efforts are needed t o create physician awareness about the WHO guidelines and their use. T his study can be used to assess the effectiveness of any future physic ian education and to identify areas of weakness in health care.