[Development of TB treatment system by liaison critical path]

Liaison critical path (LCP) for various diseases is useful to strengthen community medical cooperation and to provide better service for patients. LCP for tuberculosis is not yet spread except for a few trials, while cooperation of health center and hospitals with tuberculosis ward through community DOTS is now going to be established. We started cooperation between Higashihiroshima Medical Center and Onomichi Medical Association to provide better medical care for tuberculosis patients through LCP. The request of health care workers for LCP by questionnaire study were i) schedule of laboratory examination to check adverse reaction of medication, ii) schedule of chemotherapy, iii) report system of tuberculosis, iv) infection control and so on. LCP was made up based on these requests and the guidelines of standard chemotherapy. We made LCP to be concise and 3 parts; i) standard treatment with PZA, ii) standard treatment without PZA and iii) treatment other than standard regimen. In addition to these LCP for TB treatment, we made information sheets for i) when to suspect and how to diagnose, ii) flow chart for deciding regimen, iii) explanation of standard treatment and DOTS, iv) information for patients and their families about treatment, admission and infection control. These sheets were offered to member of medical association with referral letter on discharge from TB ward or by health center nurse just after notification of TB. Though the results of these LCP are not yet fully analyzed, following effects are expected and obtained; i) diffusion of standard chemotherapy and DOTS to medical practitioner, ii) confidence that the treatment is appropriate, iii) reduction of burden on TB hospital through early referral to general practitioner or beginning treatment without referral if admission is not necessary. LCP with community DOTS will help TB patients and healthcare workers around the patients. The most important effect of LCP is establishment of human relationship and network of health care workers molded in the process of development itself. The problems to be faced from now are diffusion of LCP to other TB hospitals and areas, participation of pharmacy and patient care system at home or nursing home. Any part of members may take initiative to develop LCP, but the role of health center nurse is important.