Appendix 21. Informing the patient

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    21.1 At the start of treatment

    Arrange two interviews (allow about 20 minutes for each): one to supply the patients with the information they need to follow the treatment, the second to make sure they have assimilated the information. These interviews should coincide with the first two clinical visits. The first interview should occur before the treatment begins. Depending on how the clinic is organized, the interviews are done either by the prescribing clinician alone at the time of the clinical visit, or with the help of a specially-trained staff member at an interview just for this purpose. Patients may bring someone with them, if they wish.


    First interview

    • Explain:
      • The disease and how it spreads
        For example: this is a serious, but generally curable, infection that affects the lungs and can be spread if not treated (tailor the information according to the focus of the infection, the resistance pattern).
      • The treatment process:
        Length, intensive/continuation phases, clinical and bacteriological monitoring, visit schedule (tailor the information according to the regimen); how DOT will work and why it is important when relevant.
      • The medications:
        • Management:
          Where, when, and from whom to get medications;
          Number of tablets per day; number of doses per day, etc.;
          Keep tablets in their blister pack until taken, no removing them from their package ahead of time.
        • Main adverse effects and what to do if they occur:
          For example: for rifampicin, point out that it turns the urine, stools, tear, etc. reddish-orange, that this is normal and not a cause for concern. For ethambutol, advise the patient to consult the doctor immediately if s/he notices a decrease in his/her vision or ability to correctly distinguish colours, etc.
        • Special precautions (depending on concomitant treatment):

    For example: take rifampicin in the morning, and fluconazole at night.

    • Any incentives or enablers the patient may qualify for and how the patient can access them.
    • Stress the importance of adherence, anticipate problems, and think about possible solutions.
    • Answer any questions.
    • Give the date of the second interview (one week later).

    Second interview (one week later)

    • Check to make sure that information has been assimilated; ask open-ended questions, give the patient time to answer. Give more information, if necessary.
    • Answer any questions.
    • Remind the patient of the date of the next visit.

    Hospitalized patients

    First interview

    Same as above, plus explain:

    • Hospital infection control measures:
    • Isolation and why it is indicated; the importance of covering the mouth when coughing or sneezing, the use of sputum containers, visits outside the building, face masks/respirators (who, when, why), airing out the room, etc.
    • Timetable for injections and distribution of drugs.

    Second interview (when patient is ready for discharge)

    • Explain:
      • Where and when to get medications, the visit schedule;
      • DOT and other treatment support as relevant.
    • Make sure that the information the patient needs to continue treatment as an outpatient has been assimilated (treatment process, medications, adverse effects and what to do, etc.).
    • Stress the importance of adherence, anticipate problems, and think about possible solutions.
    • Answer any questions.

    21.2 In the course of treatment

    Adherence interviews should take place at least monthly (more frequently if needed) throughout the entire course of treatment. Their purpose is to identify/resolve any problems resulting in poor adherence. Assessment is done either by the clinician at the monthly clinical visit, or by the nurse responsible for individual distribution of drugs.
    Adherence interviews should be quick (about 5 minutes); on the other hand, devote as much time as necessary to resolving any problems.

    The interview at the end of the intensive phase is more specifically devoted to informing the patient, because of the changes in drug regimen for the continuation phase.