巴西里约热内卢一家教学医院的抗结核治疗中断情况。

Defaulting from anti-tuberculosis treatment in a teaching hospital in Rio de Janeiro, Brazil.

作者信息

Salles C L G, Conde M B, Hofer C, Cunha A J L A, Calçada A L, Menezes D F, Sá L, Kritski A L

机构信息

Unidade de Pesquisa em Tuberculose, Serviço de Pneumologia, Departamento de Clínica Médica, Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.

出版信息

Int J Tuberc Lung Dis. 2004 Mar;8(3):318-22.

PMID:15139470

Abstract

SETTING

Few studies have investigated factors associated with defaulting from anti-tuberculosis (TB) therapy in hospital settings.

OBJECTIVE

To identify the factors associated with defaulting from treatment among TB in-patients in Rio de Janeiro city, Brazil.

DESIGN

Case-control study.

METHODS

All study participants initiated anti-tuberculosis treatment in a teaching hospital. A defaulting case was defined as a person who did not return for anti-tuberculosis medications after 60 days. Cases and controls were interviewed by a trained health care worker using a standardized form.

RESULTS

From 1 January to 31 December 1997, 228 TB cases were registered. After a review of the medical records, 39 were excluded. Household visits were performed in 189 patients; 46 subjects were identified as cases and 117 as controls. Defaulting from anti-tuberculosis treatment was observed in 66 cases (28.9%) before and in 46 (20.2%) after a home visit. After multivariate analysis, the strongest predictors of defaulting from treatment were: 1) returning card not provided (OR 0.099; 95%CI 0.008-1.2; P = 0.07), 2) not feeling comfortable with a doctor (OR 0.16; 95%CI 0.33-0.015; P = 0.001), and 3) blood pressure not measured (OR 0.072; 95%CI 0.036-0.79; P = 0.024).

CONCLUSIONS

In this hospital, the factors associated with defaulting from anti-tuberculosis treatment highlight the necessity for a structured TB Control Program. It is expected that the implementation of such a program, pursuing specific approaches, should enhance completion of anti-tuberculosis treatment and cure.

摘要

背景

很少有研究调查医院环境中与抗结核治疗违约相关的因素。

目的

确定巴西里约热内卢市结核病住院患者治疗违约的相关因素。

设计

病例对照研究。

方法

所有研究参与者均在一家教学医院开始抗结核治疗。违约病例定义为在60天后未返回领取抗结核药物的人。病例和对照由一名经过培训的医护人员使用标准化表格进行访谈。

结果

1997年1月1日至12月31日，登记了228例结核病病例。在查阅病历后，排除了39例。对189名患者进行了家访；46名被确定为病例，117名被确定为对照。在家访前，66例（28.9%）出现抗结核治疗违约，家访后46例（20.2%）出现违约。多变量分析后，治疗违约的最强预测因素为：1）未提供复诊卡（比值比0.099；95%可信区间0.008 - 1.2；P = 0.07），2）对医生感觉不自在（比值比0.16；95%可信区间0.33 - 0.015；P = 0.001），3）未测量血压（比值比0.072；95%可信区间0.036 - 0.79；P = 0.024）。