BACKGROUND OF THE STUDY: Pulmonary tuberculosis (PTB) remains one of the leading causes of morbidity and mortality in the whole world and the Philippines is one of the countries highly afflicted with this disease. One of the concerns in the management of this illness is the adherence of patient to treatment. Informing and educating patients as well as family members can aid in the better understanding of the illness and counseling is one of the methods utilized by physicians in the treatment of PTB.

OBJECTIVES: This study aimed to determine the effectiveness of counseling using Catharsis-Education-Action (C.E.A.) model of a family compared to counseling of patient alone on the adherence to anti-TB regimen in a randomized controlled trial.

METHODS: Forty patients diagnosed with PTB aged 19 years old and above seen at the OPD-FMC of UP-PGH for the months of January to September 2008. Randomization using table of random numbers was used to assign the patients to either of 2 arms. Patients were followed up after the 2nd, 4th, and 6th months of treatment. Sociodemographic data and clinical variables, perceptions about the disease, its treatment and hindrances to cure were obtained using a data collection form. Measure of adherence was based on the following parameters: set number of pills taken as reported by the patient as completed or missed, improvement or non-improvement of signs and symptoms, laboratory findings (chest x-ray and sputum AFB) and complete follow-up. Intention to treat analysis was made due to a high drop out rate. Sensitivity analysis was also done.

RESULTS: The sociodemographic and clinical data were comparable for both arms. The most common perception regarding TB is that it is contagious, as answered by the family members (12 of the 20 or 60%) and patients for both arms (18 of the 40 or 45%). Completion of the medication was the primary treatment measure to assess cure, as answered by 25 of the 40 subjects or 63% and 12 of the 20 family members or 60%. Financial constraints was the most commonly perceived reason for non-cure as answered by 11 of the 40 patients and 12 of the 20 family members or 27% and 60%, respectively. There was a statistically significant difference between the control and treatment arms with regards to adherence after the 4th and 6th months of follow-up, which leaned towards the control arm based on the intent to treat analysis. However, the trend is better in the treatment arm with regards to follow-up and completion of treatment while only 5 of the 20 patients (42%) in the control arm completed the treatment.

CONCLUSION: Clinically, those in family counseling had higher number of patients that completed treatment for tuberculosis than those in the individual counseling group. Thus, family counseling can aid in the adherence to treatment of TB. Recommendation: Periodic counseling such as the family CEA model can be used hand in hand with the anti TB regimen. This is to determine further the misconceptions/misperceptions about the disease that affect adherence to treatment.

The Filipino Family Physician, 2009 47 (4) pages