Community medical liaison guidelines for tuberculosis using the community cooperation clinical pathway--medical institution's roles in community DOTS.

The number of medical institutions that provide institutional care of tuberculosis has decreased for several reasons: the number of patients with tuberculosis has decreased; the length of hospitalization has been shortened; and medical care has become more efficient. In addition, the number of tuberculosis specialists has decreased. Patients with tuberculosis are currently treated by limited numbers of specialists under conditions such as limited hospital bed capacities. Physicians and medical institutions with little experience with tuberculosis are increasingly providing medical care. The creation of a community medical liaison for tuberculosis treatment is necessary to provide continuous appropriate medical care for tuberculosis including Directly Observed Treatment, Shortcourse (DOTS) from the initiation to the completion of treatment. It is important that community medical liaisons share roles and information among community medical institutions, for which the community cooperation clinical pathway is useful. The guidelines here show the specific requirements for cooperation between the above tuberculosis medical institutions and other community medical institutions in the treatment of patients with tuberculosis. Such cooperation is expected to ultimately improve the level and results of tuberculosis treatment1). However, major effort is required by each medical institution, tuberculosis medical institutions in particular, to construct and operate the cooperation system. Therefore, the promotion of systems such as fee for medical services, which consists of proper remuneration for labor, is also necessary. The Committee on Health and Nursing of the Japanese Society for Tuberculosis is preparing the guidelines for community DOTS and focusing on the role of the public health center. DOTS is an indispensable element for tuberculosis treatment. In-hospital DOTS has been used widely in medical institutions that provide institutional care of tuberculosis2), but DOTS is also required for the continuous treatment of patients after discharge or ambulatory treatment from the initiation of treatment. Community DOTS is proposed to encourage patients to continue medication and community medical care. However, for practicality, close cooperation among a public health center, tuberculosis medical institution, local medical institution, local social welfare institution, and dispensing pharmacy as well as other institutions is required. Although a public health center has the role of stimulating community COMMUNITY MEDICAL LIAISON GUIDELINES FOR TUBERCULOSIS USING THE COMMUNITY COOPERATION CLINICAL PATHWAY ─Medical Institution’s Roles in Community DOTS─