广州市白云区初治涂阴肺结核患者治疗依从性研究
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摘要
目的分析初治涂阴肺结核患者治疗依从性及影响因素。方法 2014年9月至2016年9月选取在广州市白云区慢性病防治中心诊断为初治涂阴肺结核并接受4个月超短程治疗的141例患者,调查其社会人口学资料和疾病相关资料,并在治疗1个月末和4个月末采用Morisky问卷(MMAS8)调查患者的治疗依从性。通过描述性分析χ~2检验及logistic回归分析等方法分析影响治疗依从性的相关因素。结果 141例接受调查的患者男性占64.54%,年龄(38.06±6.19)岁,高中及以下程度者占85.82%,具有基本医疗保险者占91.49%,家庭年收入3万～元者占85.11%。1个月末的治疗依从性得分显示,141例患者中治疗依从性得分为良好、中等及以下分别有135例(95.74%)、6例(4.26%)。4个月末治疗依从性得分为良好、中等及以下者分别有122例(86.52%)、19例(13.48%),良好等级患者数较1个月末同比下降9.63%。职业类型、是否具有基本医疗保险、年龄、家庭经济状况及文化程度等影响因素比较差异有统计学意义(χ~2=13.630、4.975、5.543、8.615、6.845,P<0.05),其中外来务工、文化程度较低、无基本医疗保险和较差的家庭经济状况是影响患者治疗依从性差的独立危险因素。结论完成4个月超短程治疗干预方案的初治涂阴肺结核患者治疗依从性较好。职业类型、文化程度、是否具有基本医疗保险及家庭经济状况是影响治疗依从性的主要因素。针对不同职业类型和文化程度的患者提供差异化的疾病干预和健康教育、提供基本医疗保险及社会救助保障能够提高患者的治疗依从性。
Objective To analyze the influencing factors of drug adherence among never-treated smear-negative pulmonary tuberculosis(TB) patients. Methods 141 patients with never-treated smear-negative TB who accepted a ultra-short four months treatment in Centre for Chronic Disease Control of Baiyun District of Guangzhou from September 2014 to September 2016 were recruited in our study.Demographic and disease-related information were collected.The Morisky Medication Adherence Scale(MMAS8) was applied in the survey of drug adherence of subjects at the end of the first and fourth month of treatment.A descriptive epidemiological method, χ~2 test and logistic regression analysis were used for data analysis. Results The mean age of study subjects was(38.06±6.19) years.Of these patients, 64.54% were males, 85.82% had an education level of high school and below, 91.49% were covered by basic medical insurance, and 85.11% had an annual household income of 30 000-120 000 RMB.Based on the MMAS, by the end of the first month and fourth month of treatment,95.74% and 86.52% of patients had high level of drug adherence,4.26% and 13.48% had medium and low level of drug adherence.Occupation,basic medical insurance,age,family income and education were closely related to the drug adherence(P<0.05),and migrating workers,the undereducated,the uninsured and the low family income were the major independent influencing factors of the drug adherence of patients with untreated smear-negative TB. Conclusions Majority of patients with untreated smear-negative TB have high level of medication adherence in a short 4 month of treatment.Occupation,basic medical insurance,age,family income and education are major influencing factors of drug adherence.It is suggested personalized interventions and management should be adopted to further increase the drug adherence of TB patients.
Objective To analyze the influencing factors of drug adherence among never-treated smear-negative pulmonary tuberculosis(TB) patients. Methods 141 patients with never-treated smear-negative TB who accepted a ultra-short four months treatment in Centre for Chronic Disease Control of Baiyun District of Guangzhou from September 2014 to September 2016 were recruited in our study.Demographic and disease-related information were collected.The Morisky Medication Adherence Scale(MMAS8) was applied in the survey of drug adherence of subjects at the end of the first and fourth month of treatment.A descriptive epidemiological method, χ~2 test and logistic regression analysis were used for data analysis. Results The mean age of study subjects was(38.06±6.19) years.Of these patients, 64.54% were males, 85.82% had an education level of high school and below, 91.49% were covered by basic medical insurance, and 85.11% had an annual household income of 30 000-120 000 RMB.Based on the MMAS, by the end of the first month and fourth month of treatment,95.74% and 86.52% of patients had high level of drug adherence,4.26% and 13.48% had medium and low level of drug adherence.Occupation,basic medical insurance,age,family income and education were closely related to the drug adherence(P<0.05),and migrating workers,the undereducated,the uninsured and the low family income were the major independent influencing factors of the drug adherence of patients with untreated smear-negative TB. Conclusions Majority of patients with untreated smear-negative TB have high level of medication adherence in a short 4 month of treatment.Occupation,basic medical insurance,age,family income and education are major influencing factors of drug adherence.It is suggested personalized interventions and management should be adopted to further increase the drug adherence of TB patients.
引文
[1] 成诗明.进一步提高我国涂阴肺结核的防治和管理水平[J].中国防痨杂志,2015,37(5):470-472.
[2] 王黎霞,成诗明,陈明亭,等.2010年全国第五次结核病流行病学抽样调查报告[J].中国防痨杂志,2012,34(8):485-508.
[3] 薛晓,马艳,刘二勇,等.涂阴肺结核患者的诊断与治疗研究进展[J].中国防痨杂志,2015,37(5):526-530.
[4] Morisky DE,Ang A,Krousel-Wood M,et al.Predictive validity of a medication adherence measure in an outpatient setting[J].J Clin Hypertens (Greenwich),2008,10(5):348-354.
[5] 中华人民共和国卫生部疾病控制司.初治涂阴活动性肺结核病人免费治疗管理指南(试行)[J].中华结核和呼吸杂志,2005,28(10):667-669.
[6] Dlugovitzky D,Notario R,Martinel-Lamas D,et al.Immunotherapy with oral,heat-killed,Mycobacterium vaccae in patients with moderate to advanced pulmonary tuberculosis[J].Immunotherapy,2010,2(2):159-169.
[7] 温宇.母牛分枝杆菌菌苗和草分枝杆菌菌苗辅助治疗初治涂阳肺结核的近期疗效观察[J].临床肺科杂志,2009,14(10):1289-1290.
[8] 丁亚奇.初治涂阴肺结核两种治疗方案的成本-效果研究[D].北京:北京协和医学院,2017.
[9] Patel AR,Campbell JR,Sadatsafavi M,et al.Burden of non-adherence to latent tuberculosis infection drug therapy and the potential cost-effectiveness of adherence interventions in Canada:a simulation study[J].BMJ Open,2017,7(9):e15108.
[10] 孙文焱.单纯肺结核与糖尿病合并肺结核患者治疗依从性影响因素的对比研究[J].中西医结合心血管病电子杂志,2017,5(31):93.
[11] 刘萍萍,林伟斌,钟耐容,等.基于互联网微信平台的流动人口肺结核患者健康教育研究[J].中国防痨杂志,2017,39(7):713-716.
[12] 谷战英.县级定点医院结核病服务提供补偿策略研究[D].济南:山东大学,2017.
[13] 钟涛,刘盛元,朱闵敏,等.深圳市南山区登记肺结核患者电子服药系统管理下督导服药情况分析[J].中国慢性病预防与控制,2016,24(5):332-336.
[14] Woodroffe R,Donnelly CA,Ham C,et al.Badgers prefer cattle pasture but avoid cattle:implications for bovine tuberculosis control[J].Ecol Lett,2016,19(10):1201-1208.
[15] 姜世闻.应用创新方法管理肺结核患者治疗提高服药依从性[J].中国防痨杂志,2017,39(7):673-676.
[2] 王黎霞,成诗明,陈明亭,等.2010年全国第五次结核病流行病学抽样调查报告[J].中国防痨杂志,2012,34(8):485-508.
[3] 薛晓,马艳,刘二勇,等.涂阴肺结核患者的诊断与治疗研究进展[J].中国防痨杂志,2015,37(5):526-530.
[4] Morisky DE,Ang A,Krousel-Wood M,et al.Predictive validity of a medication adherence measure in an outpatient setting[J].J Clin Hypertens (Greenwich),2008,10(5):348-354.
[5] 中华人民共和国卫生部疾病控制司.初治涂阴活动性肺结核病人免费治疗管理指南(试行)[J].中华结核和呼吸杂志,2005,28(10):667-669.
[6] Dlugovitzky D,Notario R,Martinel-Lamas D,et al.Immunotherapy with oral,heat-killed,Mycobacterium vaccae in patients with moderate to advanced pulmonary tuberculosis[J].Immunotherapy,2010,2(2):159-169.
[7] 温宇.母牛分枝杆菌菌苗和草分枝杆菌菌苗辅助治疗初治涂阳肺结核的近期疗效观察[J].临床肺科杂志,2009,14(10):1289-1290.
[8] 丁亚奇.初治涂阴肺结核两种治疗方案的成本-效果研究[D].北京:北京协和医学院,2017.
[9] Patel AR,Campbell JR,Sadatsafavi M,et al.Burden of non-adherence to latent tuberculosis infection drug therapy and the potential cost-effectiveness of adherence interventions in Canada:a simulation study[J].BMJ Open,2017,7(9):e15108.
[10] 孙文焱.单纯肺结核与糖尿病合并肺结核患者治疗依从性影响因素的对比研究[J].中西医结合心血管病电子杂志,2017,5(31):93.
[11] 刘萍萍,林伟斌,钟耐容,等.基于互联网微信平台的流动人口肺结核患者健康教育研究[J].中国防痨杂志,2017,39(7):713-716.
[12] 谷战英.县级定点医院结核病服务提供补偿策略研究[D].济南:山东大学,2017.
[13] 钟涛,刘盛元,朱闵敏,等.深圳市南山区登记肺结核患者电子服药系统管理下督导服药情况分析[J].中国慢性病预防与控制,2016,24(5):332-336.
[14] Woodroffe R,Donnelly CA,Ham C,et al.Badgers prefer cattle pasture but avoid cattle:implications for bovine tuberculosis control[J].Ecol Lett,2016,19(10):1201-1208.
[15] 姜世闻.应用创新方法管理肺结核患者治疗提高服药依从性[J].中国防痨杂志,2017,39(7):673-676.
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