Alvarez Gordillo Guadalupe del Carmen, Alvarez Gordillo Julio Félix, Dorantes Jiménez José Eugenio
Colegio de la Frontera Sur, Chiapas, México.
Rev Panam Salud Publica. 2003 Dec;14(6):402-8. doi: 10.1590/s1020-49892003001100005.
To implement a training program for physicians and patients and assess its effectiveness in terms of patient compliance with the pulmonary tuberculosis treatment regimen in the border region of Chiapas, Mexico.
A controlled intervention study was performed with patients over 15 years of age who had pulmonary tuberculosis diagnosed by direct microscopy (bacilloscopy) between 1 February 2001 and 31 January 2002 in health units randomly selected in the border region of Chiapas, Mexico. The sample was made up of patients who sought consultation at 23 and 25 health units over that period (intervention and control group, respectively). The intervention group took part in a training program for health personnel in which the following were discussed: the social, cultural, and economic aspects of tuberculosis; the theoretical and practical underpinnings of the diagnosis and treatment of the illness, and the establishment of self-help groups. Selfhelp groups were also created for all patients at the 23 units where the intervention group sought consultation. All patients were given a short-term treatment regimen with isoniazid, rifampin, pyrazinamide, and ethambutol for a total of 25 weeks, until completing a total of 105 doses. Patient follow-up was extended through December 2003. The intervention and control groups were compared by means of the chi square test, and Student's t test was used to compare means. The relative risk of non-compliance (RR) was calculated along with 95% confidence intervals (95% CI).
Eighty-seven patients participated in the study; 44 were exposed to the intervention, and 43 made up the control group. Compliance with treatment was considerably greater in the intervention group than in the control group (97.7% vs. 81.4%, respectively; RR = 1.20; 95% CI: 1.03 to 1.39; P = 0.0015). It was noted that physicians in the border region of Chiapas gear their activities toward curative medicine, rather than preventive medicine or understanding the social determinants of disease.
As a result of the educational activities that were part of the intervention, there was an increase in the proportion of patients who complied with treatment. Health services can improve tuberculosis control in Chiapas with the resources that are available to them at present. Physicians should be taught to view health problems in Chiapas as part of an integral set of conditions, and efforts should be made to improve the doctor-patient relationship. Steps should also be taken to incorporate educational activities and community participation in health services in order to address public health problems in a comprehensive way.
在墨西哥恰帕斯州边境地区为医生和患者实施一项培训计划，并评估其在患者对肺结核治疗方案依从性方面的效果。
对2001年2月1日至2002年1月31日期间在墨西哥恰帕斯州边境地区随机选取的卫生单位中，通过直接显微镜检查（细菌学检查）确诊为肺结核的15岁以上患者进行了一项对照干预研究。样本由在此期间分别在23个和25个卫生单位就诊的患者组成（分别为干预组和对照组）。干预组参与了一项针对卫生人员的培训计划，其中讨论了以下内容：结核病的社会、文化和经济方面；该疾病诊断和治疗的理论与实践基础，以及自助小组的建立。在干预组就诊的23个单位还为所有患者建立了自助小组。所有患者均接受了为期25周的异烟肼、利福平、吡嗪酰胺和乙胺丁醇短期治疗方案，直至完成总共105剂。患者随访延长至2003年12月。通过卡方检验对干预组和对照组进行比较，并使用学生t检验比较均值。计算了不依从的相对风险（RR）以及95%置信区间（95%CI）。
87名患者参与了研究；44名接受了干预，43名组成了对照组。干预组的治疗依从性明显高于对照组（分别为97.7%和81.4%；RR = 1.20；95%CI：1.03至1.39；P = 0.0015）。注意到恰帕斯州边境地区的医生将其活动重点放在治疗医学上，而非预防医学或对疾病社会决定因素的理解上。
作为干预措施一部分的教育活动使依从治疗的患者比例有所增加。卫生服务部门利用现有的资源可以改善恰帕斯州的结核病控制。应教导医生将恰帕斯州的健康问题视为一系列整体情况的一部分，并努力改善医患关系。还应采取措施将教育活动和社区参与纳入卫生服务，以便全面解决公共卫生问题。
