Tuberculosis (abbreviated to TB) is one of important global health hazards. Since 1993, World Health Organization (WHO) and International Union Against Tuberculosis and Lung Disease (IUATLD) have been conducting an all-out global wide campaign of integrated care for TB patients called Directly Observed Treatment Short-course (DOTS). DOTS was found to be most effective by WHO after trials in many countries with high prevalence of TB, and now it is highly recommended by WHO to all countries as a profound TB control strategy. World Bank has also made an assessment of DOTS and hails it a health investment of the highest cost benefit. DOTS is to take advantage of the watchful eyes of a trustworthy bystander to closely observe the process, ascertain that the patient would take each and every dose of prescribed TB medications, and thus make sure the patient would get cured. It is hoped to be able to spot and identify 75% of all smear positive TB patients and cure 85% among them.
For many years, both incidence and mortality rates of TB have stayed number ones among those of all notifiable communicable diseases in Taiwan. Taiwan health authority finally followed the WHO
recommendation and launched a DOTS trial program in certain mountainous rural areas in 1997, and phased into a gradual expansion in 2001 in accordance with the execution of then TB Control Year campaign. In April 2006 after the last batch of counties and cities of Taiwan joined in, a brand new
nationwide ?DOTS program? was born, in which special case carers were officially hired, and hopefully we would reach the DOTS goals set by WHO in the foreseeable future. The purpose of this study was to find out the DOTS program?s cost-effectiveness in two consecutive years, i.e. one year (2005/4/1-2006/3/31) immediately prior to the launch of the new DOTS program, and the one (2006/4/1-2007/3/31) that followed, through the expenditures for the implementation of the DOTS program, indices of therapeutic effectiveness in the two years, and at various stages of its implementation and a cost-benefit analysis of the treatments involved. The figures used in this study were mainly obtained from a Taiwan CDC database for registration of TB case notifications. The individual notified cases studied took place either in. There were 5679 notified TB cases studied. Meanwhile, we also got access to a Department of Health database of death causes and the relevant medical expenditure records from Central Regional Branch, Bureau of National Health Insurance (NHI) for necessary data using the ID number of the patient involved.
Our results indicate that during the specified two years, the age of new TB cases was still getting older, and more males turned out than females, but it seemed the program had but little influence on the
therapeutic outcomes. Fore instance, the accumulated treatment success rate one year after the initiation of the new program turned out to be 97%, somewhat improved from the rate (92.3%) in the previous year of the launch of the new program. In the aspect of mortality, the total mortality of the four counties/cities in the central region of Taiwan that died of TB one year after the implementation of the new program was 20.4%, which is clearly lower than that (22.4%) in the previous year. This indicates that the region?s total mortality did drop considerably due to the enforcing of the DOTS program. Aside from that, about the qualifying rate expressed by successfully changing from smear-positive to smear-negative within three months, there were 91.0% of all cases being successful one year after the activation of the new program, which was, as a whole, better than the 84.2% showing just one year before. Also, among all individual cases that have participated in the DOTS program, the successful changing rates were all better when covered by formal DOTS 95.0%,DOTS program .Overall speaking, to promote DOTS intervening measures turned out to be with a certain degree of positive cost effectiveness. Comparing the accomplishments of the four counties/cities of the central region of Taiwan, we found that Changsha County ranked number one and its success made it a model for the other three to learn from.
This research is trying to use mixed care districts and districts specializing in dementia cares at long-term care facilities as our research targets, to study and compare three levels of the facilities referring to environment facilities, medical care, and activity design. Furthermore, we apply the dementia elders? life adaptation and life satisfaction in the institution as the comparison of our evaluation results.
This research adopt the methods of literature reviews, observations, questionnaires, and structural questionnaires , and we will propose the related results. The objects of our research are ?Professional Dementia Nursing Home attached to Taichung Hospital ? and ?Taichung Municipal Ren-ai Senior Citizens?
Home.?
The objectives of our research are to reach the three following goals:
1. To realize the situation of the comparative care models in the dementia care institutes among environmental devices, medical care and activity design.
2. To realize dementia elders? demographic data, cognitive status, health status, life adaptation and life satisfaction.
3. To explore whether the dementia elders? life adaptation and life satisfaction in long-term care institutes are different under the two comparative models (mixed or specialized).
Research findings:
It shows that whether the dementia elders with the same demographic data or not in different dementia care models are all adapt to or almost adapt to the
life in the facilities. In addition, the dementia elders reveal average satisfactory in life satisfactory.
In environmental devices, the dementia elders living in the mixed care districts get the highest scores of life adaptation in ?activity space.?
In medical treatment, the dementia elder living in the specialized care districts get the highest scores of life adaptation in ?arranged medical treatment.?
In activity design, the two districts both have activities designed for dementia elders. Because of the limited space in specialized districts, their activity is mainly inner static activities. However, the mixed districts have their own outdoor activities. Because of their spacious space and frequent interaction with the elders, they could improve the dementia elders? social functions and postpone their degeneration.
