Patient-centered communication (PCC) is critical to improved patient experience and outcomes. We used binary logistic regression to examine how PCC at safety-net providers was associated with patient intent to recommend the facility. We used 2021-2022 national data collected by the Health Resources and Services Administration (HRSA). Our predictors were Consumer Assessment of Healthcare Providers and Systems (CAHPS) items to measure patient assessment of provider communication. We found that patients whose providers always listened carefully and knew important information about patients' medical history had 2.34 and 1.38 times the odds of recommending the facility, respectively. The odds of recommendation increased when providers always showed respect (OR = 1.44) or spent enough time with patients (OR = 1.59). Odds were also higher if administrative staff were always helpful (OR = 2.51) or treated patients courteously and respectfully (OR = 1.42). Patient-centered communication demonstrates significant potential to improve patient experience and care quality by safety-net providers.

PURPOSE:Patient experience is a key component of quality of care. This study assessed patient experiences of dental care in Armenia, identifying associated factors and gaps between patients' expectations and care provided. DESIGN/METHODOLOGY/APPROACH:We conducted a cross-sectional survey of 164 dental patients from seven randomly selected dental clinics in Yerevan's seven largest districts. A self-administered questionnaire assessed patient experience and Patient Experience Scores (PES, range 1-5) were calculated. FINDINGS:A total of 164 respondents (response rate 83%) with mean age of 42 years completed the questionnaire. Overall satisfaction with the last visit was rated "excellent" by 52% (n = 86) patients, "good" by 34% (n = 56) and "poor-fair" by 13% (n = 21). The overall mean PES was 3.92. "Respect," "Pain management" and "Safety" were scored highest, indicating that they are the most valued aspects of care. The lowest scores were observed in "General satisfaction," "Privacy" and "Quality of care." Most domains (9 of 11) were positively correlated with PES. Increasing age was associated with lower PES (OR 0.98 per year), and higher standard of living with higher PES (3.17 average, 5.64 above average as compared to below average). The single "General Satisfaction" item averaged less than 3.0 and did not track with the other PES domains, a concern since the single item is often used in place of the full scale. ORIGINALITY/VALUE:The concept of patient experience is complex. This first study of dental patient experience in Armenia provides a foundation for further research, including benchmarking and other efforts that will drive quality improvement.

INTRODUCTION:Preconception care is individualized health care designed to optimize health prior to pregnancy to reduce future pregnancy complications. Promoting preconception care for preventing pregnancy-related illnesses and death is needed, especially for those who are at highest risk. This study evaluated reception of preconception care among U.S. Black women of reproductive age. METHODS:This study used Pregnancy Risk Assessment Monitoring System data from 2016 to 2021 with a sample of Black women across 44 states, the District of Columbia, New York City, and Puerto Rico who intended to become pregnant (n = 16,071). Multivariate logistic regression models evaluated the association between prepregnancy hypertension and preconception care reception. RESULTS:Hypertensive Black women had 21% decreased odds (odds ratio [OR]: 0.79, confidence interval: 0.72-0.87) of receiving preconception care, compared with their counterparts without prepregnancy hypertension. An inverse dose-response was observed: As education and household income increased, the odds of receiving preconception care services decreased significantly (education: (OR: 1.39-0.64; income: OR: 0.74-0.30). CONCLUSIONS:These findings affirm that hypertensive Black women had lower odds of receiving preconception care services compared with Black women who did not begin pregnancy with hypertension. Given that women with chronic conditions would have more reasons to receive care prior to pregnancy, this finding is disconcerting.

INTRODUCTION/OBJECTIVE:Reducing inappropriate emergency room (ER) visits is a major health management objective. While Hispanic patients reportedly have the highest percentage of avoidable ER visits (4.89%), empirical research is scarce. Effective provider communication can increase appropriate ER utilization. Our objective was to examine associations between safety net primary care providers' communication with Hispanic patients and Hispanic patients' ER use. METHODS:We used 2022 Health Center Patient Survey data collected by the United States Health Resources and Services Administration. Our predictors were patient-reported provider communication and nonclinical staff evaluation items from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) instrument. Our outcome variable was patient-reported ER visits in the previous year. We used binary logistic regression to examine the association. RESULTS:Patients who had used health centers longer had significantly lower odds of ER visits (44%-46%). Patients who had initiated conversations about their health issues had 55% higher odds of ER visits. Healthier patients and women had lower odds while insured patients and those with frequent visits to health centers had higher odds of ER use. CONCLUSIONS:Primary care continuity, stable medical home, and effective interactions with providers may reduce ER use.

INTRODUCTION:US patients with behavioral health conditions have smoking rates two to three times higher than the general population. Tobacco-free environments at substance use disorder (SUD) facilities can positively impact patient's outcomes as well as the health of staff, but client perceptions to the contrary can slow adoption. This study assessed client and staff beliefs, attitudes, and knowledge regarding the implementation of a tobacco-free campus policy at McLeod Addictive Disease Center, a full-service SUD treatment facility based in Charlotte, North Carolina. METHODS:During the height of the 2020 COVID-19 pandemic, the research team conducted a mixed-methods study at the McLeod Center lasting from May to November 2020. Using convenience sampling, the team conducted two staff surveys that were administered online (n=134; n=28) and virtual interviews of clients (n=38) to assess beliefs, attitudes and knowledge of tobacco use and the tobacco-free campus planned for 2021. RESULTS:Many staff identified as current or former smokers (n=57); some expressed the belief that the policy will positively impact clients' SUD recovery (n=12). Encouragingly, clients expressed positive feelings associated with the policy (n=16) and reported interest in receiving tobacco cessation treatment (n=25). CONCLUSIONS:Staff are interested in helping clients quit tobacco use. Most of the interviewed clients, however, believed that utilizing tobacco products while receiving treatment for their dependence on another substance, would improve their success. The McLeod Center was one of the first community-based SUD treatment facilities in North Carolina to transition to a 100% tobacco-free campus in 2021. This research and results serve as a blueprint for other facilities making similar policy changes.

Objectives This study aimed (1) to determine the impact of a clinical decision support (CDS) tool on rate of opioid prescribing and opioid dose for patients with chronic musculoskeletal conditions and (2) to identify prescriber and facility characteristics associated with adherence to the Centers for Disease Control and Prevention guideline for prescribing opioids for chronic pain in this population.We conducted an interrupted time series analysis to assess trends in percentage of patients from 2016 to 2020, receiving an opioid and the average opioid dose, as well as the change associated with implementation of the CDS toolkit. We conducted a retrospective cohort study to assess the association between prescriber and facility characteristics and safe opioid-prescribing practices.Methods We assessed the impact of the CDS intervention on percent of patients receiving an opioid and average opioid dose (morphine milligram equivalents). We operationalized safe opioid prescribing as a composite score of several behaviors (i.e., prescribing naloxone, initiating a pain agreement, prescribing <90 MME, avoiding extended-release prescriptions for opioid-naive patients, and avoiding coprescribing opioids and benzodiazepines) and used a hierarchical linear regression model to assess associations between prescriber and facility characteristics and safe opioid prescribing.Results This CDS intervention had a modest but statistically significant 1.6% reduction on the percent of patients ( n = 1,290,746) receiving an opioid (mean: 15% preintervention; 10% postintervention). The average dose of opioid prescriptions did not significantly change. Advanced practice providers and prescribers with higher percentages of patients aged 18 to 64 exhibited safer opioid prescribing, while prescribers with higher percentages of white patients and larger numbers of patients on opioids exhibited less safe opioid prescribing.Conclusion A CDS intervention was associated with a small improvement in percent of patients receiving an opioid, but not on average dose. Clinicians are not prescribing opioids for chronic musculoskeletal conditions frequently, when they do, they are generally adhering to guidelines.

OBJECTIVES:North Carolina had implemented legislation (Strengthen Opioid Misuse Prevention (STOP) Act) limiting opioid prescriptions to 5 days for acute pain and 7 days for post-operative pain. This study aimed to identify patient, prescriber, and facility characteristics associated with STOP Act adherence for patients with acute or post-surgical musculoskeletal (MSK) conditions.DESIGN:A three-level hierarchical logistic regression model was used to predict odds of adherence with STOP Act duration limits, accounting for fixed and random effects at the patient, prescriber, and facility levels.SETTING:A large healthcare system in North Carolina.PATIENTS AND PARTICIPANTS:Patients (N = 6,849) presenting from 2018 to 2020 with a diagnosis of an acute MSK injury.INTERVENTIONS:The STOP Act limited the duration of opioid prescriptions in North Carolina.MAIN OUTCOME MEASURE:Prescriptions adhering to the STOP Act duration limits of 5 days (nonoperative) or 7 days (operative) were the primary outcome.RESULTS:Opioids were compliant with STOP Act duration limits in 69.3 percent of encounters, with 33 percent of variation accounted for by clinician and 29 percent by facility. Patients prescribed >1 opioid (odds ratio (OR) 0.46, 95 percent confidence interval (CI): 0.36, 0.58) had reduced odds of a compliant prescription; surgical patients had increased odds of a compliant prescription (outpatient surgery: OR 5.89, 95 percent CI: 2.43-14.29; inpatient surgery: OR 7.71, 95 percent CI: 3.04-19.56). Primary care sports medicine clinicians adhered to legislation less frequently than orthopedic surgeons (OR 0.38, 95 percent CI: 0.15, 0.97).CONCLUSIONS:Most prescriptions adhered to STOP Act legislation. Tailored interventions to improve adherence among targeted groups of prescribers, eg, those treating nonoperative injuries and sport medicine clinicians, could be useful.

Objectives: To assess whether implementation of the Strengthen Opioid Misuse Prevention (STOP) Act was associated with an increase in the percentage of opioid prescriptions written for 7 days or fewer among patients with acute or postsurgical musculoskeletal conditions. Design: An interrupted time-series study was conducted to determine the change in duration of opioid prescriptions associated with the STOP Act. Setting: Data were extracted from the electronic health record of a large health care system in North Carolina. Subjects: Patients presenting from 2016 to 2020 with an acute musculoskeletal injury and the clinicians treating them were included in an interrupted time-series study (n = 12 839). Methods: Trends were assessed over time, including the change in trend associated with implementation of the STOP Act, for the percentage of prescriptions written for <= 7 days. Results: Among patients with acute musculoskeletal injury, less than 30% of prescriptions were written for <= 7 days in January of 2016; by December of 2020, almost 90% of prescriptions were written for <= 7 days. Prescriptions written for <= 7 days increased 17.7% after the STOP Act was implemented (P <.001), after adjustment for the existing trend. Conclusions: These results demonstrate significant potential for legislation to influence opioid prescribing behavior.

High quality health care requires competent, motivated, and satisfied health care employees. This research examines whether employee job satisfaction differs at for-profit (FP) and not-for-profit (NFP) hospitals and how other organizational characteristics mediate this relationship. In this cross-sectional study, Press Ganey Employee Partnership Survey data from 35 Florida hospitals were used to understand the relationship between hospital ownership (primary independent variable) and employee job satisfaction (outcome). A flexible structural equation model was used to examine the relationship. The sample included 32,892 valid responses (approximately 23% from FP hospitals). Employees in FP hospitals were found to less satisfied with their jobs than their NFP counterparts. This trend was strongly associated with an inverse relationship between job satisfaction and assessment of immediate supervisors. The resulting job satisfaction model had an R2 of 0.524, indicating good fit. Further analyses revealed a positive association between perceived staffing levels and supervisor satisfaction, suggesting that the relative leanness of FP institutions might explain the observed difference in supervisor satisfaction. Employee job satisfaction is a complex multifaceted construct. Four main organizational factors affect employee job satisfaction: the organization’s ownership type (FP or NFP), employee relationships with supervisors, work schedule, and length of employment. Leaders need to provide front line supervisors with adequate resources and support. Training immediate supervisors how to approach and be supportive of their workers provides an immediate solution toward increasing employee job satisfaction.

Background Few prognostic tools are currently available to predict hospital mortality in patients with acute type A aortic dissection. The aim of this study was to validate the performance of two existing risk-assessment tools, the original and the adjusted Leipzig-Halifax scorecards, to predict hospital mortality among Armenian patients with acute type A aortic dissection. Methods This retrospective cohort study included all consecutive patients with acute type A aortic dissection who were admitted to two tertiary cardiac centers in Armenia and underwent surgery from January 2008 to April 2018. We evaluated the predictive power of the original and adjusted Leipzig-Halifax scorecards using logistic regression analysis. Results Overall, 211 patients (76% males, mean age 57 ± 9 years) were included in the study, of whom 37 (17.5%) died during hospitalization. The adjusted Leipzig-Halifax score, but not the original Leipzig-Halifax score, was a significant predictor of hospital mortality. Patients with medium and high adjusted Leipzig-Halifax scores had a significantly higher odds of death compared to patients with low scores (odds ratio = 3.0 vs. 3.9, 95% confidence interval: 1.3–6.9 vs. 1.0–14.9, respectively). The areas under the receiver operating characteristic curves were 0.58 and 0.63, respectively, p > 0.05. Conclusion The adjusted Leipzig-Halifax score performed slightly better than the original Leipzig-Halifax score in the Armenian acute type A aortic dissection population. The adjusted Leipzig-Halifax score should now be applied prospectively to generate more data for further validation and potential improvement.

Background WHO’s directly observed therapy (DOT) strategy for tuberculosis (TB) treatment depends upon a well–organized healthcare system. This study sought to evaluate the effectiveness of self-administered drug intake supported by a family member versus in-clinic DOT. Methods This open–label, nationally-representative stratified cluster randomized controlled non–inferiority trial with two parallel equal arms involved drug–susceptible pulmonary TB patients in the continuation treatment phase. We randomly assigned outpatient–TB–centres (52 clusters) to intervention and control arms. The intervention included an educational/counseling session to enhance treatment adherence; weekly visits to outpatient–TB–centres to receive medication, and daily SMS medication reminders and phone calls to track adherence and record side effects. Controls followed clinical DOT at Outpatient–TB–centres. Both groups participated in baseline and 4–5 months follow–up surveys. The trial’s non–inferiority comparisons include: treatment success as the clinical (primary) outcome and medication adherence (self–reported), knowledge, depressive symptoms, stigma, quality of life, and social support as non–clinical (secondary) outcomes. Results Per–protocol analysis showed that the intervention ( n = 187) and control ( n = 198) arms achieved successful treatment outcome of 92.0 and 92.9%, respectively, indicating that the treatment success in the intervention group was non–inferior to DOT. Knowledge, depression, stigma, quality of life, and social support also showed non–inferiority, demonstrating substantial improvement over time for knowledge (change in the intervention = 1.05: 95%CL (0.49, 1.60); change in the control = 1.09: 95%CL (0.56, 1.64)), depression score (change in the intervention = − 3.56: 95%CL (− 4.99, − 2.13); change in the control = − 1.88: 95% CL (− 3.26, − 0.49)) and quality of life (change in the intervention = 5.01: 95%CL (− 0.64, 10.66); change in the control = 7.29: 95%CL (1.77, 12.81)). The intervention resulted in improved treatment adherence. Conclusions This socially empowering alternative strategy might be a preferable alternative to DOT available to patients in Armenia and in other countries. Further research evaluating cost effectiveness of the intervention and generalizability of the results is warranted. Trial registration Clinicaltrials.gov : NCT02082340 , March 10, 2014.

CONTEXT As of March 23, 2012, the Internal Revenue Service (IRS) requires tax-exempt hospitals to conduct Community Health Needs Assessment (CHNA) every 3 years to incentivize hospitals to provide programs responsive to the health needs of their communities. OBJECTIVE To examine the distribution and variation in community benefit spending among North Carolina's tax-exempt hospitals 2 years after completing their first IRS-mandated CHNA. DESIGN Cross-sectional study using secondary analysis of published community benefit reports. Community benefit was categorized on the basis of North Carolina Hospital Association's community benefit reporting guidelines. Multiple regression analysis using generalized linear model was used to examine the variation in community benefit spending among study hospitals considering differences in hospital-level and community characteristics. SETTING Fifty-three private, nonprofit hospitals across North Carolina. MAIN OUTCOME MEASURE Dollar expenditures as a percentage of operating expenses of the 2 categories of community benefit spending: patient care financial assistance and community health programs. RESULTS Study hospitals' aggregate community benefit spending was $2.6 billion, 85% of which was in the form of patient care financial assistance, with only 0.7% of total spending allocated to community-building activities such as affordable housing, economic development, and environmental improvements. On average, the study hospitals' community benefit spending was equivalent to 14.6% of operating expenses. Hospitals with 300 or more beds provided significantly higher investments in community health programs as a percentage of their operating expenses than hospitals with 101 to 299 beds (P = .03) or hospitals with 100 or fewer beds (P = .04). Access to care was not associated with patient care financial assistance (P = .81) or community health programs expenditures (P = .94). CONCLUSIONS The study hospitals direct most of their community benefit expenditures to patient care financial assistance (individual welfare) rather than population health improvement initiatives, with virtually no investments in community-building activities that address socioeconomic determinants of health.

As of March 23, 2012, the Internal Revenue Service (IRS) requires tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every 3 years. This study assessed whether the IRS CHNA mandate incentivized North Carolina's tax-exempt hospitals to increase investments in community health programs. The authors gathered the 2012-2016 community benefit reports of 53 North Carolina private, nonprofit hospitals from the North Carolina Hospital Association. Community benefit spending data from the year of the first CHNA were compared to that 2 years later using paired t tests among matched subjects. No significant increases were found in hospitals' community health programs spending (P = 0.6920) or in providing patient care financial assistance (charity or discounted care) (P = 0.0934). In fact, aggregate community health programs spending effectively decreased by 4%, from $393.3 million to $377.5 million. Among all community benefit items, only the unreimbursed cost for treating Medicare patients increased significantly (P = 0.0297). The proportion of spending on community health programs relative to patient care financial assistance decreased significantly (P = 0.0338). Performing CHNAs did not incentivize North Carolina's tax-exempt hospitals to progressively invest in community health programs. The hospitals continue to spend heavily on patient care financial assistance and little on disease prevention and community health improvement activities. These findings suggest that tax-exempt hospitals continue to function as a safety net for the poor and the uninsured rather than as active partners in population health management initiatives. At present, performing CHNAs may be more a demonstration of compliance than a tool to improve population health.

The health care industry collects ever-increasing volumes of patient data. Currently, this largely untapped "big data" primarily documents encounters and facilitates billing. This issue of the North Carolina Medical Journal explores the promise and the perils of big data as we seek to transform our health care system into one that is more proactive, equitable, and value based.

Objectives Prenatal care (PNC) is a critical preventive health service for pregnant women and infants. While timely PNC has been associated with improved birth outcomes, improvements have slowed since the late 1990s. Therefore, focus has shifted to interventions prior to pregnancy. Preconception care is recommended for all women of reproductive age. This study aimed to examine preconception care and its association with timeliness and adequacy of PNC. Methods This retrospective cohort study used data from a large sample of United States first-time mothers (n = 13,509) who participated in the 2009–2011 Pregnancy Risk Assessment Monitoring System in ten states. Timeliness and adequacy of PNC data came from birth certificates, while preconception care receipt was self-reported. Logistic regression provided odds ratios (ORs) and 95% confidence intervals (CIs) to model the association between preconception care receipt and the two PNC outcomes. Results After adjustment, women who received preconception care had statistically significant increased odds of timely (OR 1.30, 95% CI 1.08, 1.57), but not adequate PNC (OR 1.08, 95% CI 0.94, 1.24) as compared to women who did not receive preconception care. Pregnancy intention modified these associations. Associations were strongest among women with intended pregnancies (timely PNC: OR 1.63 and adequate PNC: OR 1.22). Conclusions for Practice Given that untimely PNC is associated with adverse birth outcomes, the observed association warrants increased focus on implementing preconception care. Future studies should investigate how specific components of preconception care are associated with PNC timeliness/adequacy, health behaviors during pregnancy, and birth outcomes.

Background: Free clinics are volunteer based organizations that provide health care services to low-income individuals for free or minimal cost. Communities served by a free clinic can provide ambulatory care services for uninsured individuals, reducing reliance on costly hospital admissions for ambulatory care sensitive conditions. This study examines whether free clinics in North Carolina reduce hospitalizations for ambulatory care sensitive conditions for uninsured adults. Methods: The study used North Carolina hospital discharge data from 2003 to 2007, restricted to uninsured adults residing in North Carolina (N = 270,325). Prevention Quality Indicators identified hospitalizations for ambulatory care sensitive conditions. The entry of new free clinics in some counties during this time period in conjunction with county-level and year fixed effects allows the logistic regression analysis to simulate a pre/post study design. Results: Discharges for ambulatory care sensitive conditions constituted 12.6% of the sample. Despite the limited coverage provided by free clinics, which serve 5.5% of the uninsured in North Carolina, uninsured adults in counties served by a free clinic had an 8.0% reduced odds of a hospitalization being for an ambulatory care sensitive condition. When the model is limited to ambulatory care sensitive conditions related to chronic conditions, the odds of a hospitalization of an uninsured adult for an ambulatory care sensitive condition in counties served by a free clinic is reduced by 9.0%. Conclusion: Free clinics are effective providers of primary care services for uninsured individuals, particularly for those with chronic conditions. To enhance this impact by increasing free clinics' reach, state and local policy makers should support and encourage development of free clinics in high need areas.

Coronary artery bypass grafting (CABG), one of the treatment approaches for coronary artery disease, can be conducted with (on-pump) or without (off-pump) the use of a heart-lung machine. The long-term benefits of off-pump versus on-pump (traditional) CABG are debatable. This study compared on-pump and off-pump 5 year event-free survival from major cardiac and cerebrovascular events (MACCE) and quality of life of patients who underwent on-pump versus off-pump CABG surgery. This retrospective cohort study included all patients who underwent CABG at Nork Marash Medical Center (NMMC), Armenia from 2009 to 2010. Data were collected from patient telephone surveys (March 2015), the NMMC electronic surgical database, and medical records. Among 528 patients, 407 (77.1%) underwent on-pump and 121 (22.9%) off-pump CABG. The groups differed at baseline by age, gender, prevalence of hypertension, cerebrovascular disease, gastrointestinal disease, and diabetes. The average EuroSCORE was significantly higher in the off-pump group, indicating a higher surgical risk. The mean follow-up time was 58.2 months for the on-pump and 59.5 months for the off-pump groups. Overall patient health status, estimated via the EQ-5D visual analogue scale, showed no significant differences. After controlling for EuroSCORE and diabetes, the hazard of developing MACCE was similar (HR=0.96 for on-pump versus off-pump, 95% CI: 0.56-1.65). At 5-year follow-up, no significant differences were observed in the risk of developing major cardiac and cerebrovascular events or quality of life between the off-pump and on-pump CABG patients. Further research is needed to define the patient populations that will benefit the most from each type of surgery.

Objectives: The objective of this study was to examine the associations among race, education, income, and health-related quality of life (HRQoL) in self-care of type 2 diabetes mellitus among adults in North Carolina.Methods: A secondary analysis was conducted using data from the 2009 Behavioral Risk Factor Surveillance Survey (BRFSS), a large population-based survey (N = 432,607) conducted in the United States. The data were analyzed to account for the weighted complex multistage sampling design of the Behavioral Risk Factor Surveillance Survey. Parametric testing using univariate/bivariate/multivariate analysis was performed.Results: The majority of participants reported taking a class/course on diabetes mellitus management and having checked their blood glucose levels at least once per day. The majority (61.26%) of the participants did not have good self-management skills, based on the education and blood glucose-monitoring criteria established for this study. Participants with poor HRQoL had significantly increased odds of good diabetes mellitus self-care practices.Conclusions: Individuals with poor HRQoL had significantly increased odds of good diabetes mellitus self-care practices. Although findings on race, education, and income were not statistically significant, they were consistent with previous research. In the future, individuals who are nonwhite, have less than a high school level of education, and have no health insurance should be targeted to improve diabetes mellitus self-care practices through educational and informational materials. Further investigation using more comprehensive measures of diabetes mellitus self-care is warranted.

BACKGROUND:Tuberculosis is a major public health concern resulting in high rates of morbidity and mortality worldwide, particularly in low- and middle-income countries. Tuberculosis requires a long and intensive course of treatment. Thus, various approaches, including patient empowerment, education and counselling sessions, and involvement of family members and community workers, have been suggested for improving treatment adherence and outcome. The current randomized controlled trial aims to evaluate the effectiveness over usual care of an innovative multicomponent people-centered tuberculosis-care strategy in Armenia.METHODS/DESIGN:Innovative Approach to Tuberculosis care in Armenia is an open-label, stratified cluster randomized controlled trial with two parallel arms. Tuberculosis outpatient centers are the clusters assigned to intervention and control arms. Drug-sensitive tuberculosis patients in the continuation phase of treatment in the intervention arm and their family members participate in a short educational and counselling session to raise their knowledge, decrease tuberculosis-related stigma, and enhance treatment adherence. Patients receive the required medications for one week during the weekly visits to the tuberculosis outpatient centers. Additionally, patients receive daily Short Message Service (SMS) reminders to take their medications and daily phone calls to assure adherence and monitoring of treatment potential side effects. Control-arm patients follow the World Health Organization--recommended directly observed treatment strategy, including daily visits to tuberculosis outpatient centers for drug-intake. The primary outcome is physician-reported treatment outcome. Patients' knowledge, depression, quality of life, within-family tuberculosis-related stigma, family social support, and self-reported adherence to tuberculosis treatment are secondary outcomes.DISCUSSION:Improved adherence and tuberculosis treatment outcomes can strengthen tuberculosis control and thereby forestall tuberculosis and multidrug resistant tuberculosis epidemics. Positive findings on effectiveness of this innovative tuberculosis treatment people-centered approach will support its adoption in countries with similar healthcare and economic profiles.TRIAL REGISTRATION:ClinicalTrials.gov registration number: NCT02082340. Date of registration: 4 March 2014.