[Use of a risk assessment inventory in implementation of the community DOTS in Shinjuku, Japan].

PURPOSES: To investigate the effectiveness of a risk assessment for implementing the DOTS of outpatients in the Japanese city of Shinjuku. SUBJECTS: A total of 435 patients with tuberculosis or latent tuberculosis infection who were registered in the city of Shinjuku between 1 April 2005 and 31 December 2007. METHODS: Soon after their diagnosis or registration and again 4 months thereafter, the patients were interviewed by the public health nurse in charge using a risk assessment inventory that had 17 scales related to the risk of defaulting from the treatment. Based on the results of the risk assessment, the patients were provided with an appropriately adapted DOTS. RESULTS: Out of all patients, 386 (88.7%) were assessed twice, of whom 338 (77.7%) were those with active disease. The patients were classified into three groups according to their risk scales: high-, medium-, and low-risk groups. There was no change in the risk grouping during the 4 months in 307 (90.8%) patients. However, in 12 patients (3.6%) the risk level was increased after 4 months, because of the development of side effects and problems with regular outpatient visits. The common methods of support in drug taking were daily DOT at the health center for patients in the high-risk group, and DOT at pharmacy shops once or twice weekly with self-medication on the other days for patients in the medium-risk group. For the low-risk group, the public health nurses made interview once or twice a month. There was no significant difference in the treatment success rate, default rate, or mortality rate among these three groups. DISCUSSION: The treatment outcome suggests that the community DOTS in this area may be effective. It was important to assess possible risks in treatment for each patient in order to identify the support needs and means. Also, it is necessary to develop a good risk assessment inventory scale.