177. Ambulatory chemotherapy was first introduced in this Service in 1950 because of the small number of hospital beds available. As time and experience established the ellicacy of ambulatory treatment, hospital beds began to be used as a supplement to the ambulatory treatment. The beds were used mainly for cases whose disease was not controlled at the clinic and some of whom required surgical intervention, for the isolation of certain types of case and for investigation where the diagnosis was in doubt.
178. The advantages of ambulatory treatment are:
(1) Effective treatment can be given at about one-twentieth of the
cost of orthodox hospital treatment;
(ii) Considerably larger numbers of patients can be dealt with by
the available trained staff:
(i) During the course of treatment the patient can continue to
maintain his family and avoids losing his job.
179. In Hong Kong. ambulatory chemotherapy offers means of controlling a tuberculosis problem which is far beyond the capacity of the available hospital beds. Further, as there is no general community sick benefit scheme, it provides treatment in a form acceptable to the patient.
180. Treatment is given in courses each lasting three months and is carried on for periods varying between the lower limit of six months and two and a half years or longer. Where it appears that the prognosis is poor a trial period of six months treatment is given with proprietary drugs: in the face of failure to respond, wreatment is discontinued. In more hopeful cases treatment is continued until no further improvement can be achieved.
181. Keeping in mind the dangers of the dissemination of resistant organisms, treatment usually consists of a combination of two or some- times three of the standard drugs PAS, INAH and Streptomycin; the latter is given either daily or by biweekly injection. A few proprietary drugs are also used. Plans are in operation to obtain PAS and INAH made up together in one tablet with the object of preventing the patient taking only one drug and discarding the less palatable PAS. Drug intolerance is encountered infrequently.
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182.
Details of cases treated were as follows:
TABLE 13
1956
1957
Brought forward from last year Started treatment during the year
1,703
5.887
7,861
7,964
Total treated during the year
9.564
13,851
Completed treatment
1,037
1,213
Treatment incomplete
Failed to attend. Admitted to hospital
2,022
2,868
445
495
Transferred elsewhere Died
140
95
33
43
5,887 9,132
Still under treatment at the end of the year
183. The overall increase in the figures, particularly the number remaining on treatment at the end of the year, indicates the increase in the volume of the work done.
184. The number of cases who completed treatment is still very small, the average duration of treatment being just under fifteen months. The results of treatment were as follows:
Improved Unchanged
Worse
Information incomplete
Total
759
396
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10
1,313
185. Comparing results in Hong Kong and Kowloon the percentages improved were 69% and 58% respectively,
186. The total of those who failed to complete treatment is dis- appointingly high, most of them stopping within the first three months despite efforts made to encourage reattendance. The principal reason given for failure was 'too busy to attend." It is known, however, that some cases, once diagnosis is completed, go to 'Charity Clinics' or "Workers Clinics' and have treatment there. It is common practice to use the Government clinics as a check on the diagnosis of pulmonary tuberculosis made elsewhere and then to go back to the original source for treatment once the diagnosis has been confirmed.
187. Medicines for symptomatic treatment are available for all clinic patients. Complete records of the number of attendances for symptomatic treatment are not available as it is not easy to separate these from the attendances recorded for other purposes.
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