On the differences in attitude and awareness of clinical doctors, health administrators and other health workers to tuberculosis treatment in Japan and the US
Masuyama, H.; Aoki, M.
Kekkaku 75(6): 413-422
2000
ISSN/ISBN: 0022-9776 PMID: 10918786 Document Number: 513799
Peculiarity of TB treatment in Japan is a higher rate and duration of hospitalization than in other developed countries. Improvement of the TB control policy in Japan necessitates reexamination of the issue of treatment policy, which requires consideration of recognition and understanding of the concept of TB infection, human rights and the protection of patients as well as the society. Therefore, this study aims at clarifying and analyzing the differences in TB treatment policies in Japan and the US. For the US, a questionnaire was sent to TB Directors of states and large cities in order to analyze TB control policies. Moreover, the author attended the NTCA meeting held in Chicago to interview 16 TB Directors. In Japan, the author sent the same questionnaire translated into Japanese to medical doctors in 54 National TB sanatoria. The hospitalization rates of new smear-positive TB patients were 100% (median) in Japan and 59% in the US. The periods of hospitalization of these patients were 150 days (median) in Japan and 10 days in the US. The total expenses of TB diagnosis and treatment per capita were approximately US $25,000 and 20,000, respectively in Japan and the US. If the DOT strategy were applied to the new smear-positive TB cases in Japan, those total expenses would be reduced to half. On the measures against the TB patients who pose a threat to the public, the US has the series of TB control strategies which contain the reporting system, home isolation, incarceration and penalties for violation, while Japan has only the strategy of hospitalization. The TB policies of Japan in future would need to focus more selectively and carry out thoroughly as seen in the US. The recommended TB policies for Japan obtained from this study are to set TB policies adapted to regional characteristics and to review the strategy against patients posing a threat to the public.