Directly Observed Therapy (DOT) for the Treatment of Tuberculosis
What is DOT?
DOT means that a trained health care worker or other designated individual (excluding a family member) provides the prescribed TB drugs and watches the patient swallow every dose.
Why use DOT?
- We cannot predict who will take medications as directed, and who will not. People from all social classes, educational backgrounds, ages, genders, and ethnicities can have problems taking medications correctly.
- Studies show that 86-90% of patients receiving DOT complete therapy, compared to 61% for those on self-administered therapy.
- DOT helps patients finish TB therapy as quickly as possible, without unnecessary gaps.
- DOT helps prevent TB from spreading to others.
- DOT decreases the risk of drug-resistance resulting from erratic or incomplete treatment.
- DOT decreases the chances of treatment failure and relapse.
Who can deliver DOT?
- A nurse or supervised outreach worker from the patient’s county public health department normally provides DOT.
- In some situations, it works best for clinics, home care agencies, correctional facilities, treatment centers, schools, employers, and other facilities to provide DOT, under the guidance of the local health department.
- Family members should not be used for DOT. DOT providers must remain objective.
- For complex regimens including IV/IM medications or twice daily dosing, home care agencies may provide DOT or share responsibilities with the local health department.
- If resources for providing DOT are limited, priority should be given to patients most at risk. See the MDH DOT Risk Assessment form for help identifying high-priority patients.
How is DOT administered?
- DOT includes:
- delivering the prescribed medication
- checking for side effects
- watching the patient swallow the medication
- documenting the visit
- answering questions
- DOT should be initiated when TB treatment starts. Do not allow the patient to try self-administering medications and missing doses before providing DOT. If the patient views DOT as a punitive measure, there is less chance of successfully completing therapy.
- The prescribing physician should show support for DOT by explaining to the patient that DOT is widely used and very effective. The DOT provider should reinforce this message.
- DOT works best when used with a patient-centered case management approach, including such things as:
- helping patients keep medical appointments
- providing ongoing patient education
- offering incentives and/or enablers
- connecting patients with social services or transportation
- Patients taking daily therapy can usually self-administer their weekend doses.
How can a DOT provider build rapport and trust?
- “Start where the patient is.”
- Protect confidentiality.
- Communicate clearly.
- Avoid criticizing the patient’s behavior; respectfully offer helpful suggestions for change.
- Be on time and be consistent.
- Adopt and reflect a nonjudgmental attitude.