Disconnecting the DOTS: misconceptions about the therapeutic paradigm of tuberculosis patients at family healthcare centers in Istanbul

Abstract

Purpose There has been a major transformation in the Turkish healthcare system since 2003. The new paradigm introduced the family medicine model, which profoundly changed the structure of primary healthcare access and delivery. In the context of tuberculosis (TB) control, it led to transferring the responsibility for directly observed therapy (DOT) from anti-TB clinics to family healthcare centers. This change entailed daily interaction of the health staff of family healthcare centers with TB patients who had been treated solely in anti-TB clinics under the vertical system since the 1940s. These encounters resulted in erroneous DOT practices and inappropriate treatment of TB patients. In this study, we attempt to question the ways in which TB control has so far been and will possibly be affected by this change.