BACKGROUND: Private sector involvement is essential for the success of the National TB Program (NTP). However, despite the introduction of the Public-Private Mix DOTS (Directly Observed Therapy Short Course) initiative, private sector role remains limited. This may be due to restrictions in the program policies which may limit the potentials of private physicians and patients from participating.

OBJECTIVE: The study aims to determine the feasibility and effectiveness of an alternative model for the delivery of DOTS services through private physicians engaged in single clinic or Stand-Alone Practice (SAP).

METHODS: Private practitioners trained in the DOTS strategy with private clinics in Quezon City were invited to participate in a pilot study on a Stand-Alone Practice (SAP) model for the delivery of DOTS services. The model adheres to the five essential components of the DOTS strategy, but allows the patient to choose between referral to a DOTS facility or management by the SAP physician in his clinic. All patients undergo sputum microscopy and TB cases receive the recommended NTP regiments under the supervision of a designated treatment partner. Recording and reporting procedures are patterned after the NTP.

RESULTS: Over a period of one year, 25 of 28 physicians who agreed to participate were able to enroll 456 patients. Seventy percent had smears done, of which 56% were smear-positive. There were 363 identified TB cases; 59 were referred to a DOTS center while 304 were managed by the SAP physicians. Based on actual recording, treatment completion was 71% among referred patients and 51% among SAP-managed patients. Adherence to recording and reporting procedures was suboptimal and many physicians failed to properly reflect smear and chest x-ray results, regimen prescribed, and outcome of treatment.

CONCLUSION: The SAP model is feasible and encouraging, and was able to detect and complete treatment in a significant number of TB cases. However, adherence to recording and reporting procedures must be improved.

Human ; Male ; Female ; Directly Observed Therapy ; Patient Compliance ; Tuberculosis ; Therapeutics ; Therapy ; Physicians ; Private Sector

BACKGROUND: Evidence-Based Medicine (EBM) has brought about a paradigm shift in medical practice. However, evidence in peer-reviewed medical journals is inaccessible to a lay person for whom the newspaper is the most accessible source of information. This study aims to determine if medical news articles (MNAs) in leading local newspapers in the Philippines are based on good evidence.

OBJECTIVES: To characterize MNAs based on: (1) references cited and their level of evidence as appraised by authors and two independent EBM experts; (2) use of clinical outcomes; (3) mention of treatment beneft and potential harm in measurable terms; (4) mention of cost of treatment; and (5) disclosure of pharmaceutical industry support.

METHODS: MNAs on non-surgical prevention and treatment of adult diseases from January to June 2002 in three leading local Philippine newspapers were appraised. MNAs on diagnosis, pediatric and surgical treatments, multiple treatment modalities, columns were excluded. References were assessed independently by two EBM experts; diferences were resolved by consensus.

RESULTS: The fve conditions most frequently reported on were: diabetes, coronary heart disease, cancer, arthritis and hypertension. Of 113 MNAs, 94 (83%) cited references4 were medical journal articles, 34 (63%) of which were based on good quality evidence. Out of the 94 MNAs, 51 (54%) reported clinical endpoints, 31 (33%) quantifed beneft, 21 (22%) cited potential harm, 22 (23%) disclosed industry support, and 4 (4%) mentioned cost of treatment. None of the MNA authors mentioned critically appraising their references.

CONCLUSION: The 113 MNAs published in three leading local newspapers in the Philippines during the six-month period showed shortcomings in providing information to beneft the public. EBM awareness among journalists and studies covering a longer period and a broader line of the print media are recommended.

Disclosure ; Consensus ; Philippines ; Medical Writing ; Drug Industry ; Mass Media ; Diabetes Mellitus ; Hypertension ; Coronary Disease ; Evidence-based Medicine ; Arthritis ; Neoplasms