The New England journal of medicine
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After an increase in the number of cases of tuberculosis, New York City passed regulations to address the problem of nonadherence to treatment regimens. The commissioner of health can issue orders compelling a person to be examined for tuberculosis, to complete treatment, to receive treatment under direct observation, or to be detained for treatment. On the basis of a review of patients' records, we evaluated the use of these legal actions between April 1993 and April 1995. ⋯ For most patients with tuberculosis, even those with severe social problems, completion of treatment can usually be achieved without regulatory intervention. Patients were detained on the basis of their history of tuberculosis, rather than on the basis of their social characteristics, and the less restrictive measure of mandatory directly observed therapy was often effective.