Practical study concerning improvements in tuberculosis care practice.

With tuberculosis now relatively well contained in Japan, it is important to reconfigure treatment systems and structures to ensure the most appropriate treatments in the future. A survey of designated tuberculosis treatment facilities in Hiroshima Prefecture revealed declining standards of tuberculosis diagnosis and treatment as well as decreasing knowledge levels in regional areas, suggesting the need for improved collaboration between tuberculosis specialists and regional health care providers. A tuberculosis care pathway designed to promote improved collaboration between referring medical institutions and clinics, and the DOTS (directly observed treatment, short-course) Notebook for patient advice and assistance with compliance, were developed jointly by the Higashihiroshima Medical Center and the Onomichi Medical Association. Following the introduction of tuberculosis care pathway and the DOTS Notebook, we have seen a number of improvements, notably an increase in successful treatment outcomes in regional areas and fewer patients receiving treatment for more than 12 months. These results suggest that better liaison through the regional coordination pathway has led to improved tuberculosis treatment in regional areas. While further refinements and modifications are necessary, it is clear that this represents a step forward in tuberculosis care, and will provide the impetus to bring about meaningful changes to the system.