Liefooghe R, Suetens C, Meulemans H, Moran M B, De Muynck A
Institute of Tropical Medicine, Antwerp, Belgium.
Int J Tuberc Lung Dis. 1999 Dec;3(12):1073-80.
Tuberculosis Department, Bethania Hospital, Sialkot, Pakistan.
To determine whether intensive counselling can improve treatment adherence.
In a randomised controlled intervention trial of 1,019 adult tuberculosis patients, 49% were assigned to the intervention group and 51% to the control group. Baseline data were obtained through semi-structured interviews. Patients were followed until the end of treatment (cure, default, referral or death). The intervention included counselling at the start of treatment and at each subsequent visit for ambulatory patients, or weekly for hospitalised patients. Counselling combined health education with strategies to strengthen patients' self-efficacy. Control group patients received the usual care. The outcome measure was treatment default.
The default rate was 54% in the control group and 47% in the intervention group: the default risk ratio was 0.87, implying a reduction in defaulting of 13%. The impact was stronger in women, ambulatory patients, re-treatment patients, women who worked in the home, and patients who were not the main provider, those with a poor knowledge of the disease or those with a short treatment delay.
Intensive counselling has a significant, although limited, impact on treatment adherence.
巴基斯坦锡亚尔科特贝瑟尼亚医院结核病科。
确定强化咨询是否能提高治疗依从性。
在一项针对1019名成年结核病患者的随机对照干预试验中，49%被分配到干预组，51%被分配到对照组。通过半结构化访谈获取基线数据。对患者进行随访直至治疗结束（治愈、违约、转诊或死亡）。干预措施包括在治疗开始时以及随后每次门诊就诊时对门诊患者进行咨询，或对住院患者每周进行一次咨询。咨询将健康教育与增强患者自我效能感的策略相结合。对照组患者接受常规护理。结局指标为治疗违约。
对照组的违约率为54%，干预组为47%：违约风险比为0.87，这意味着违约率降低了13%。这种影响在女性、门诊患者、复治患者、家庭主妇以及非主要供养者、对疾病了解不足或治疗延迟短的患者中更为明显。
强化咨询对治疗依从性有显著但有限的影响。
