不同督导模式对涂阳肺结核患者治疗管理效果的研究
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摘要
目的比较不同督导模式下新涂阳肺结核患者的治疗管理效果,为探索科学、高效的结核病患者管理模式提供理论依据。方法将2016年1月-2018年6月确诊的新涂阳患者随机分组,纳入常规医务人员督导模式组(对照组)和新型综合督导模式组(实验组),随访观察至治疗结束,比较不同督导模式下2月痰阴转率、患者服药率、按时查痰率、治愈率、不良反应发生率的差异。结果与常规督导组相比,新型综合督导模式组2月痰未转阴的风险降低73.7%(OR=0.263,95%CI:0.094～0.733)),未按时查痰的风险降低31.1%(OR=0.689,95%CI:0.478～0.994)),不规则治疗的风险降低65.7%(OR=0.343,95%CI:0.156～0.753),治疗失败的风险降低65.0%(OR=0.350,95%CI:0.155～0.791),发生不良反应的风险降低54.9%(OR=0.451,95%CI:0.219～0.926)。新型综合督导模式中医务人员电话督导模式效果最佳。结论新型综合督导模式可有效提高患者的治疗依从性及治疗效果,是切实可行的肺结核督导管理方法,其中医务人员电话督导模式效果最优。
Objective To compare the management effect of new smear-positive pulmonary tuberculosis(TB) patients under different supervision modes, so as to provide theoretical basis for exploring scientific and efficient management mode of TB patients. Methods From 2016.1 to 2018.6, newly diagnosed smear-positive cases were randomized into the conventional supervision mode group(control group) and the new supervision mode group(experimental group). Patients were followed-up until the end of treatment, and then compared for the 2-month sputum negative conversion rate, regular reexamination rate,regular medicine-taking rate, cure rate and the incidence of adverse drug reactions between different supervision modes.Results Compared with the control group, the risk of 2-month sputum-smear positive in the experimental group decreased by73.7%(OR=0.263, 95% CI: 0.094-0.733), the risk of failure to review sputum on schedule decreased by 31.1%(OR=0.689,95% CI: 0.478-0.994), the risk of irregular medicine-taking decreased by 65.7%(OR=0.343, 95 %CI: 0.156-0.753), the risk of treatment failure decreased by 65.0%(OR=0.350, 95% CI: 0.155-0.791), and the risk of drug adverse reactions decreased by 54.9%(OR =0.451, 95% CI: 0.219-0.926). Comprehensive evaluation indicated that telephone supervision performed by medical staff of community health service center were the most effective. Conclusion The new supervision mode on the management of pulmonary tuberculosis patients is helpful to improve the medication compliance and therapeutic effects and it is feasible. Everyday telephone supervision performed by medical staff of community health service center was the best intervention mode.
Objective To compare the management effect of new smear-positive pulmonary tuberculosis(TB) patients under different supervision modes, so as to provide theoretical basis for exploring scientific and efficient management mode of TB patients. Methods From 2016.1 to 2018.6, newly diagnosed smear-positive cases were randomized into the conventional supervision mode group(control group) and the new supervision mode group(experimental group). Patients were followed-up until the end of treatment, and then compared for the 2-month sputum negative conversion rate, regular reexamination rate,regular medicine-taking rate, cure rate and the incidence of adverse drug reactions between different supervision modes.Results Compared with the control group, the risk of 2-month sputum-smear positive in the experimental group decreased by73.7%(OR=0.263, 95% CI: 0.094-0.733), the risk of failure to review sputum on schedule decreased by 31.1%(OR=0.689,95% CI: 0.478-0.994), the risk of irregular medicine-taking decreased by 65.7%(OR=0.343, 95 %CI: 0.156-0.753), the risk of treatment failure decreased by 65.0%(OR=0.350, 95% CI: 0.155-0.791), and the risk of drug adverse reactions decreased by 54.9%(OR =0.451, 95% CI: 0.219-0.926). Comprehensive evaluation indicated that telephone supervision performed by medical staff of community health service center were the most effective. Conclusion The new supervision mode on the management of pulmonary tuberculosis patients is helpful to improve the medication compliance and therapeutic effects and it is feasible. Everyday telephone supervision performed by medical staff of community health service center was the best intervention mode.
引文
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[4]杨华林,包昌林,白丽琼,等.电话督导与传统督导对湖南农村肺结核患者干预效果的比较[J].中国防痨杂志,2012,33(10):646-650.
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[8]黎永华,李朝勇,黄隆.三亚市老年肺结核患者治疗失败的影响因素调查分析[J].中国卫生统计,2017,34(1):85-86,90.
[9]文凯,马健.家庭督导化疗管理对初治涂阳肺结核患者服药依从性的影响及效果分析[J].中国医学创新,2015,12(3):124-126.
[10]曾慧频,赵红,钟艳华,等.家庭支持督导对耐多药肺结核患者服药依从性的影响[J].内科,2016,11(3):483-485.
[11]郑利群.电话督导与传统督导方式对肺结核患者治疗管理效果的探讨[J].中国卫生产业,2017,14(4):50-51.
[12]孙捷.强化健康教育对肺结核患者服药依从性的影响[J].齐鲁护理杂志,2013,19(15):18-19.
[2]叶浩森,董晓欣,侯万里,等.DOTS策略在结核病防治中的应用进展和存在的问题[J].公共卫生与预防医学,2013,24(4):69-70.
[3]陆峰,徐红,符剑.应用手机短信管理肺结核患者依从性调查与分析[J].中国防痨杂志,2012,34(10):651-654.
[4]杨华林,包昌林,白丽琼,等.电话督导与传统督导对湖南农村肺结核患者干预效果的比较[J].中国防痨杂志,2012,33(10):646-650.
[5]周林,薛晓,王芳,等.结核病管理模式的实施方法研究[J].中国防痨杂志,2013,35(2):120-124.
[6]Wright J,Walley J,Philip A,et al.Direct observation of treatment for tuberculosis:a randomized controlled trial of community health workers versus family members[J].Tropical Medicine and International Health,2004,9(5):559-565.
[7]郑莉莉,周琳,蒋莉,等.深圳市初治涂阳肺结核治愈影响因素分析[J].现代预防医学,2012,39(9):2139-2141.
[8]黎永华,李朝勇,黄隆.三亚市老年肺结核患者治疗失败的影响因素调查分析[J].中国卫生统计,2017,34(1):85-86,90.
[9]文凯,马健.家庭督导化疗管理对初治涂阳肺结核患者服药依从性的影响及效果分析[J].中国医学创新,2015,12(3):124-126.
[10]曾慧频,赵红,钟艳华,等.家庭支持督导对耐多药肺结核患者服药依从性的影响[J].内科,2016,11(3):483-485.
[11]郑利群.电话督导与传统督导方式对肺结核患者治疗管理效果的探讨[J].中国卫生产业,2017,14(4):50-51.
[12]孙捷.强化健康教育对肺结核患者服药依从性的影响[J].齐鲁护理杂志,2013,19(15):18-19.