Download DIRECTLY OBSERVED PREVENTIVE THERAPY (DOPT)

DIRECTLY OBSERVED THERAPY (DOT)
&
DIRECTLY OBSERVED PREVENTIVE
THERAPY (DOPT)
What it is & what it is not
In a recent memorandum originating from the Bureau of
Communicable Disease Control at the Texas Department
of Health in Austin, the significance and value of
DOT/DOPT was addressed from the point of view of what
these very special adjuncts to tuberculosis
chemotherapy are and what they are not. Clarification of
these procedures is meant to insure uniformity of
understanding and increase effectiveness through
standardized use. While there are few published studies
defining the value of DOT/DOPT, the experience of Dr.
Stephen Weis in Fort Worth, Texas* has contributed
significantly to developing the concept of DOT
treatments as standard protocol, especially in areas of
the United States where the risk of acquiring or
developing tuberculosis, particularly drug resistant
tuberculosis, is considered to be relatively high.
Because Texas is one of these high risk areas,
understanding DOT and DOPT is particularly important
for all health care professionals working in this state. As
part of its mission to support the Public Health
Department and enhance the quality of health care in the
state, The Center for Pulmonary and Infectious Disease
Control (CPIDC), located at The University of Texas
Health Center at Tyler (UTHCT) is providing copies of the
original memorandum to health care professional and
outreach workers.
DOT/DOPT DEFINED:
In DOT/DOPT, each patient with tuberculosis disease or
infection receives medication at an appointed place and
time and is observed ingesting EVERY DOSE.
Successful DOT actually REDUCES the incidence of
DRUG RESISTANCE and the RATE of RELAPSE of TB.
Effective DOPT actually DECREASES the PROBABILITY
that someone INFECTED with the TB organism will
develop active TB disease.
THE TUBERCULOSIS ELIMINATION DIVISION POLICY IS
THAT ALL CASES AND SUSPECTS SHOULD BE ON DOT.
ALL TB PATIENTS WHOSE ORGANISMS ARE
RESISTANT TO ISONIAZID, RIFAMPIN OR BOTH
ISONIAZID AND RIFAMPIN MUST BE ON DOT.
*Weis, S.E., Slocum, P.C., Blais, F.X., et al. The Effect of
Directly Observed Therapy on the Rates of Drug Resistance
Relapse in Tuberculosis. N Eng J Med 1994; 330: 1179-84.
DOT/DOPT IS...
1. ... a treatment technique where an outreach worker or
health care provider OBSERVES the patient TAKING and
SWALLOWING all anti-tuberculosis medications for each
and every dose (of drugs) until completion of therapy.
2. ... When the patient is actually OBSERVED swallowing
EVERY dose of DOT medications, especially when
prescribed in divided doses.
3. ... provided ONLY by an outreach worker or health
care provider who is TRAINED in observing, recognizing,
documenting and reporting possible side effects of
medications to a supervisor.
4. ... when the outreach worker or health care provider
AND the patient co-sign that the medication was ingested
and that toxicity was denied by the patient.
5. ... when outreach workers or health care providers
report DAILY, to their supervisor, those DOT/DOPT doses
successfully administered as well as those that were
missed.
If financial assistance is needed for special
DOT/DOPT situations, please contact
TB Elimination at
(512) 458-7447.
DOT/DOPT IS NOT...
1. ... allowing a family member or friend to supervise and
observe a patient taking the prescribed medication
without the DOT worker being present.
2. ... allowing a parent or guardian to administer
medication to a child or adolescent without the DOT
worker present.
3. ... allowing an inmate in a correctional institution to
swallow a dose of medication without observation.
4. ... leaving medication at the patient's homesite when
the patient is not present.
5. ... leaving the medication at the patient's bedside in a
hospital, nursing home or other medical facility.
6. ... dispensing medication and "verifying" ingestion by
performing a weekly pill count.
7. ... permitting medical professionals (physicians &
nurses) to self-administer their medications.
For answers to questions regarding DOT/DOPT
policy and practice, please contact
Marilyn Metcalf, also at
(512) 458-7447.