Moulding T S, Caymittes M
Department of Respiratory and Critical Care Physiology and Medicine, Harbor UCLA Medical Center, Torrance, California 90509, USA.
Int J Tuberc Lung Dis. 2002 Apr;6(4):313-9.
A tuberculosis clinic in Haiti using self-administered medication.
To determine if medication monitors could be used along with directly observed therapy in developing countries to help solve the problem of compliance with medication.
Patients were randomized into three groups: Group A took medication from medication monitors and were given counseling based on the monitor record; Group B took medication from medication monitors, but the record was not available for counseling; and Group C took medication from simple containers.
Good monitor records in the first 11 weeks predicted less default from treatment (P < 0.01), and better compliance (P < 0.01) in the last 9 months. Counseling based on the monitor record appeared to reduce treatment abandonment by about half.
This study suggests that medication monitoring of self administered treatment would be useful in settings where directly observed therapy cannot be delivered for the entire duration of treatment, especially in rural areas, by 1) identifying poor compliance early in therapy, 2) reducing the frequency of clinic visits for patients with good monitor records who live excessive distances from the clinic, 3) counseling patients about their monitor record to improve treatment completion rates, and 4) lengthening the duration of therapy when poor compliance is found.
海地一家使用自我给药方式的结核病诊所。
确定在发展中国家，药物监测器能否与直接观察治疗法一起使用，以帮助解决药物依从性问题。
患者被随机分为三组：A组从药物监测器中获取药物，并根据监测记录接受咨询；B组从药物监测器中获取药物，但记录不可用于咨询；C组从普通容器中获取药物。
前11周良好的监测记录预示着治疗期间较少出现违约情况（P < 0.01），且在最后9个月依从性更好（P < 0.01）。基于监测记录的咨询似乎能将治疗中断率降低约一半。
本研究表明，在无法在整个治疗期间实施直接观察治疗法的情况下，尤其是在农村地区，自我给药治疗的药物监测可能会有帮助，具体体现在以下方面：1）在治疗早期识别依从性差的患者；2）对于监测记录良好但住得离诊所很远的患者，减少其门诊就诊频率；3）根据监测记录为患者提供咨询，以提高治疗完成率；4）当发现依从性差时延长治疗时间。
