Retrospective Study of Measuring Tuberculosis Therapy Compliance: Greece as a Host Country for Vulnerable Populations Before and During the Financial Crisis

Abstract

Background:For the realization of “2015 UN Millennium Development Goals”, a question arises pertaining to the course of tuberculosis in Greece and its relationship to patient adherence to treatment, given the fact that the country is undergoing a financial crisis and is a gateway for economic migrants.Methods:The study concerned 1179 patients of the anti-TBdepartment, “Sotiria” General Chest Diseases Hospital, Athens, Greece collaborating with the National Reference Centre of Mycobacteria, covering a year before the financial crisis, 2007 and 2010-11, the first years of the crisis. A special recording form was used, on the basis of a specific protocol.Results:Out of 954 patients were diagnosed with tuberculosis disease, 657 of which were foreigners. Out of 791 patients residing in the same area, 632 were foreigners. Of the patients who proceeded to a first self-discontinuation of the medication, only 38.3% (n=18) completed the treatment, while 40.4% of them self-discontinued within the first month. Duration of treatment was 6.68±3.54 months for those (n=805) with no discontinuation and 7.48±3.68 months for those (n=149) with at least one discontinuation, regardless of the etiology p= 0,032. Cases increased during financial crisis, with gradual decrease in mean treatment duration for patients with first line treatment to 7.77±3.81 months in 2007, and 6.53±3.47 and 6.40±3.31 months in 2010 and 2011, respectively.Conclusions:Since the beginning of treatment measurable signs of either adherent/non-adherent behavior appeared, affecting mean treatment duration and completion. Duration of treatment decreased in the years of financial crisis. Migrants ghettoization calls for implementation of DOTS.

Treatment compliance and noncompliance in psychoses

“…The figures of noncompliance in nonpsychiatric patients in some Indian studies are HIV-30%,[ 22 ] tuberculosis-6 to 50%[ 23 24 25 ] multidrug-resistant tuberculosis-19%,[ 26 ] hypertension-28.9%,[ 27 ] diabetes mellitus-42.3%,[ 28 ] head and neck cancer-23.5%,[ 29 ] cervical cancer-61.1%,[ 30 ] curative cancer treatment-33.33%,[ 31 ] lung cancer-36%. [ 32 ] Even in studies conducted abroad noncompliance has been reported in various medical conditions; tuberculosis global noncompliance rate-61.7%,[ 33 ] HIV optimal treatment-68%,[ 34 ] hypertension-30.5%,[ 35 ] diabetes mellitus (new detection)-20.6%. [ 36 ] It has been reported that adequate adherence is found only in the 1 st year of treatment in breast cancer patients.…”

Emergency inguinal hernioplasties in a tertiary public Hospital in Athens Greece, during the economic crisis

“…For Greece in particular, the protracted and severe financial crisis was combined with strict austerity measures implemented by the Greek Government since the beginning of 2010. Well documented effects of this combination are the increase of the burden of COPD [1], and its pharmacological treatment cost [2], increased death rates from nervous system diseases and mental health problems [3], increased deaths due to adverse events during medical treatment [4], increased rates of suicide attempts particularly in males [5], decrease by nearly 50% of the number of solid organ transplantations from deceased donors [6], poor out-of-hospital outcome of acute coronary syndrome in patients with low annual income [7], decrease of both the duration and the completion of anti-tuberculosis therapy [8], increased infant mortality [9] and dramatic decrease (by 15%) in livebirths rate [10]. In total, the health indicators for the Greek population worsened more than those of other countries similarly affected by recession [11].…”