Title: Conducting home visits for patients who miss a dose
Course: Communicable Diseases Part 2 - Ethiopia (Full)

Conducting home visits for patients who miss a dose

Give the patient the missed doses one day at a time. Do not give an extra dose on any days.

If a patient misses a dose of anti-tuberculosis medication during intensive treatment for more than 24 hours, find the patient by making a home visit within the next couple of days. Use the address on the patient's TB registration to find the patient. When you go on the home visit, take the patient's drugs with you. If the patient is not at home, ask the family or neighbours where the patient is and see if you can find out why treatment was missed. If necessary, visit the contact person listed on the patient's TB registration.

When the patient is found, talk to the patient and the family about the problem that caused the interruption in treatment. Ask direct questions such as: 'Why did you miss your appointment?' and 'Will this problem happen again?' When you have found the cause of the problem, try to help the patient to solve it with the help of the information given in Table 15.2.

Table 15.2 Some examples of possible causes and solutions for missed doses of anti-TB medication.

Examples of possiblecauses of missed doses | Possible solutions
Coming to the health facility is inconvenient. | Identify a convenient community TB treatment supporter.
Patient dislikes coming to the health facility because of the long queue. | Make arrangements so that TB patients do not have to wait in a queue. For example, let them enter through a back or side door.
Supervisor at work kept the patient late.
- Offer to talk with the supervisor and explain the importance of the treatment, or
- Identify a community TB treatment supporter at work.
Patient had troublesome side-effects.
- Give appropriate advice for side effects, or
- Refer the patient for further evaluation.
Patient had difficulty swallowing because of pain (due to oral ulceration, common in AIDS patients). | Give appropriate advice and refer patient as necessary for further evaluation.
Patient cannot leave small children at home and is tired of bringing them to the health facility.
- Suggest that a family member or neighbour watch the children.
- Remind family members/neighbours that the patient must continue treatment to protect their health, and particularly the health of the children.
- If possible, identify a community TB treatment supporter closer to the patient's home.
The patient may simply need to be forced to comply and be reminded of the reasons not to interrupt treatment.
Remind the patient of the need to take all of the recommended drugs together, for the recommended time, to be cured. Even after beginning to feel better, the patient must continue taking the drugs for the entire period of treatment.

Motivate the patient with statements such as the following:

- TB can be cured if you keep coming for the medicine, and then you will not have to worry about it any more.
- You only have 10 more doses to take every day. After that, you will come less often.
- These are the safest, most effective drugs available to treat TB anywhere in the world.
- Almost all patients who take their medicines as recommended are cured.
- If you keep taking your medicine, you will not spread TB to your family.