Increasing the Efficacy of School-Based Directly Observed Therapy: From Needs Assessment to Program Implementation

Abstract

In 1995, 43 Essex County, New Jersey, children received school nurse directly observed therapy (DOT) for tuberculosis. School-year adherence was 78.5% compared to summer adherence at 93.5%. The only nurse-involved adherence enhancement was individualized education. In early 1996, nurses completed a questionnaire determining DOT challenges. A cross-sectional study later emphasized nurse characteristics and DOT problems and successes. Problems were categorized as student, student’s family, school administration, and school environment. The assessment elicited problem resolutions as education, skills training, and resources; 26% of nurses indicated eliminating school DOT. There were statistically insignificant relationships between nurses’ personal characteristics or reported barriers and student adherence. Resulting interventions included needs-appropriate individual and group education, pediatric nurse case management, and dosing procedure changes. As a result, the 1996 school-based DOT adherence rate increased to 91.1% and continued to be above 90% for 3 consecutive years.

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References

American Academy of Pediatrics, Committee on Infectious Diseases . (2000). Tuberculosis. In L. K. Pickering (Ed.), 2000 Red Book: Report of the Committee on Infectious Diseases (25th ed., pp. 593-613). Elk Grove Village, IL: American Academy of Pediatrics.

Buttaro, T. M. , Ezell, B. , & Gray, V. (1995). A care plan for children with TB. Public Health Nursing, 12, 181-188.

Centers for Disease Control and Prevention . (1994). Improving patient adherence to TBtreatment. Atlanta, GA: Author.

Centers for Disease Control and Prevention . (1996). Tuberculosis control laws—United States, 1993: Recommendations of the Advisory Council for the Elimination of Tuberculosis (ACET). Mortality and Morbidity Weekly Report, 42(RR-15), 1-28.

Centers for Disease Control and Prevention . (1999). Patient adherence to tuberculosis treatment. In Centers for Disease Control and Prevention (Ed)., Self study modules on tuberculosis: Module 9 (pp. 38-43). Atlanta, GA: Author.

Centers for Disease Control and Prevention . (2000). Core curriculum on tuberculosis (4th ed.). Atlanta, GA: Author.

Centers for Disease Control and Prevention & American Thoracic Society . (1994). Treatment of tuberculosis infection and tuberculosis disease in adults and children. American Journal of Respiratory and Critical Care Medicine, 49, 327-345.

Charron-Prochownik, D. , Becker, M. H. , Brown, M. B. , Liang, W. , & Bennett, S. (1993). Understanding young children’s health beliefs and diabetes regimen adherence. Diabetes Educator, 19, 405-418.

Cohen, F. L. (1997). Adherence to therapy in tuberculosis. Annual Review of Nursing Research, 15, 153-184.

10.

Dick, J. , & Lombard, C. (1997). Shared vision: A health education project designed to enhance adherence to anti-tuberculosis treatment. International Journal of Tuberculosis and Lung Disease, 1, 181-186.

11.

Fagan, R. (1995). Health of the nation targets: Where school nurses find constraints on achievement. Nursing Standard, 9, 36-40.

12.

Gregory, E. K. (2000). Empowering students on medication for asthma to be active participants in their care: An exploratory study. Journal of School Nursing, 16, 20-27.

13.

Harrigan, J. (1994). Nursing practice management. Journal of School Nursing, 10, 37-40.

14.

Institute of Medicine . (2000). Ending neglect: The elimination of tuberculosis in the United States. Washington, DC: National Academy Press.

15.

Jackson, M. M. (1993). TB in infants, children and adolescents: New dilemmas with an old disease. Pediatric Nursing, 19, 437-442.

16.

Jackson, M. M. , & McLeod, R. P. (1998). TB in infants, children and adolescents: An update with case studies. Pediatric Nursing, 24, 411-416, 419-426, 447-448.

17.

Klien, S. J. , & Naizby, B. E. (1995). New linkages for tuberculosis prevention and control in New York City: Innovative use of non-traditional providers to enhance completion of therapy. Journal of Community Health, 20,5-13.

18.

Moss-Morris, R. , & Paterson, J. (1995). Understanding children’s concepts of health and illness: Implications for developmental therapists. Physical and Occupational Therapy in Pediatrics, 14, 95-108.

19.

Rubel, A. J. , & Garro, L. C. (1992). Social and cultural factors in the successful control of TB. Public Health Reports, 107, 626-636.

20.

Russell, F. F. , Mills, B. C. , Zucconi, T. (1988). Relationship of parental attitudes and knowledge to treatment adherence in children with PKU. Pediatric Nursing, 14, 514-516.

21.

Simone, P. M. , & Dooley, S. W. (1995). Multidrug-resistant tuberculosis. Atlanta, GA: Centers for Disease Control and Prevention.

22.

Steyn, M. , van der Merwe, N. , Dick, J. , Borcherds, R. , & Wilding, R.J.C. (1997). Communication with TB patients: A neglected dimension of effective treatment. Curatonis: South African Journal of Nursing, 20, 53-56.

23.

Sumartojo, E. (1993). When TB treatment fails: A social behavioral account of patient adherence. American Review of Respiratory Disease, 147, 1311-1320.