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

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.