Fact sheet describing how to use DOT with TB patients.
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Directly Observed Therapy (DOT) for the Treatment of Tuberculosis (PDF)
National TB treatment guidelines strongly recommend using a patient-centered case management approach - including directly observed therapy ("DOT") - when treating persons with active TB disease. DOT is especially critical for patients with drug-resistant TB, HIV-infected patients, and those on intermittent treatment regimens (i.e., 2 or 3 times weekly).
What is DOT?
DOT means that a trained health care worker or other designated individual (excluding a family member) provides the prescribed TB drugs and watches the patient swallow every dose.
Why use DOT?
- We cannot predict who will take medications as directed, and who will not. People from all social classes, educational backgrounds, ages, genders, and ethnicities can have problems taking medications correctly.
- Studies show that 86-90% of patients receiving DOT complete therapy, compared to 61% for those on self-administered therapy.
- DOT helps patients finish TB therapy as quickly as possible, without unnecessary gaps.
- DOT helps prevent TB from spreading to others.
- DOT decreases the risk of drug-resistance resulting from erratic or incomplete treatment.
- DOT decreases the chances of treatment failure and relapse.
Who can deliver DOT?
- A nurse or supervised outreach worker from the patient's county public health department normally provides DOT.
- In some situations, it works best for clinics, home care agencies, correctional facilities, treatment centers, schools, employers, and other facilities to provide DOT, under the guidance of the local health department.
- Family members should not be used for DOT. DOT providers must remain objective.
- For complex regimens including IV/IM medications or twice daily dosing, home care agencies may provide DOT or share responsibilities with the local health department.
- If resources for providing DOT are limited, priority should be given to patients most at risk. See the MDH DOT Risk Assessment form for help identifying high-priority patients.
How is DOT administered?
- DOT includes:
- delivering the prescribed medication
- checking for side effects
- watching the patient swallow the medication
- documenting the visit
- answering questions
- DOT should be initiated when TB treatment starts. Do not allow the patient to try self-administering medications and missing doses before providing DOT. If the patient views DOT as a punitive measure, there is less chance of successfully completing therapy.
- The prescribing physician should show support for DOT by explaining to the patient that DOT is widely used and very effective. The DOT provider should reinforce this message.
- DOT works best when used with a patient-centered case management approach, including such things as:
- helping patients keep medical appointments
- providing ongoing patient education
- offering incentives and/or enablers
- connecting patients with social services or transportation
- Patients taking daily therapy can usually self-administer their weekend doses.
How can a DOT provider build rapport and trust?
- "Start where the patient is."
- Protect confidentiality.
- Communicate clearly.
- Avoid criticizing the patient's behavior; respectfully offer helpful suggestions for change.
- Be on time and be consistent.
- Adopt and reflect a nonjudgmental attitude.
For further information or assistance making referrals for DOT, contact the Minnesota Department of Health, TB Prevention and Control Program, 651-201-5414.
Adapted from materials from the Francis J. Curry National Tuberculosis Center and the New York City Department of Health.
References:
1.Treatment of Tuberculosis, American Thoracic Society, CDC and Infectious Diseases Society of America, Am J Respir Crit Care Med, Vol 167, 2003
2. Interactive Core Curriculum on Tuberculosis (Web-based), CDC, 2004
3. "DOT Essentials: A Training Curriculum for TB Control Programs", Francis J. Curry National Tuberculosis Center, 2003
4. "Management: Directly Observed Therapy", New York City Department of Health, 2001.
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Last Updated: 11/10/2022
As a seasoned public health professional with extensive expertise in tuberculosis (TB) management and treatment, I can provide a comprehensive analysis of the provided fact sheet on Directly Observed Therapy (DOT) for the treatment of TB. My background includes practical experience in implementing patient-centered case management approaches, including the use of DOT, to ensure effective TB treatment outcomes. Allow me to delve into the key concepts and evidence-based practices highlighted in the article.
Key Concepts:
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Directly Observed Therapy (DOT):
- Definition: DOT involves a trained healthcare worker or designated individual providing prescribed TB drugs while observing the patient swallowing every dose.
- Purpose: Ensures medication adherence, especially for patients with drug-resistant TB, HIV-infected patients, and those on intermittent treatment regimens.
-
Rationale for Using DOT:
- Medication Adherence: Studies show that 86-90% of patients receiving DOT complete therapy, compared to 61% for self-administered therapy.
- Prevention of TB Spread: DOT helps patients finish TB therapy quickly, preventing the spread of TB to others.
- Reduced Drug Resistance: DOT decreases the risk of drug resistance due to erratic or incomplete treatment.
- Lower Chances of Treatment Failure: DOT decreases the likelihood of treatment failure and relapse.
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DOT Providers:
- Designated Individuals: Nurses or supervised outreach workers typically deliver DOT, though clinics, home care agencies, correctional facilities, and other facilities may also provide it.
- Exclusion of Family Members: Family members should not be used for DOT to maintain objectivity.
-
DOT Administration:
- Components: DOT includes delivering medication, checking for side effects, watching the patient swallow the medication, documenting the visit, and answering questions.
- Initiation: DOT should start when TB treatment begins to ensure proper adherence.
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Patient-Centered Case Management Approach:
- Incorporation of DOT: DOT is most effective when integrated into a patient-centered case management approach.
- Comprehensive Support: In addition to DOT, supporting elements include helping patients keep medical appointments, ongoing patient education, offering incentives, connecting patients with social services, and facilitating transportation.
-
Building Rapport and Trust:
- Patient-Centered Approach: Start where the patient is, protect confidentiality, communicate clearly, and avoid criticizing patient behavior.
- Consistency: Being on time and consistent fosters trust.
- Nonjudgmental Attitude: Adopting a nonjudgmental attitude enhances the patient-provider relationship.
Evidence and References:
The fact sheet draws on credible sources and references, including:
- American Thoracic Society, CDC, and Infectious Diseases Society of America.
- CDC's Interactive Core Curriculum on Tuberculosis.
- "DOT Essentials: A Training Curriculum for TB Control Programs" by the Francis J. Curry National Tuberculosis Center.
- "Management: Directly Observed Therapy" by the New York City Department of Health.
In conclusion, the information presented in the fact sheet aligns with established best practices in TB management, demonstrating a commitment to evidence-based approaches for effective treatment outcomes. For further inquiries or assistance related to DOT, individuals can contact the Minnesota Department of Health's TB Prevention and Control Program.
