Hsieh Chia-Ju, Lin Li-Chan, Kuo Benjamin Ing-Tiau, Chiang Chi-Huei, Su Wei-Juin, Shih Jen-Fu
Cardinal Tien College of Nursing, Taipei, Taiwan.
J Clin Nurs. 2008 Apr;17(7):869-75. doi: 10.1111/j.1365-2702.2006.01924.x.
To explore the efficacy of hospitals using case management with Directly Observed Treatment - Short course (DOTS) to monitor the adherence of patients with pulmonary tuberculosis in Taiwan.
Non-adherence to anti-tuberculosis chemotherapy is the major problem in treating patients with tuberculosis. Community-based case management coupled with DOTS has been applied to patients with tuberculosis and has resulted in good results in some countries. Taiwan has a high incidence of tuberculosis, and although it has implemented DOTS, the expected increased efficacy has not yet been realized.
The study used a quasi-experimental design. Using age and gender as matching factors, 96 subjects were randomly assigned to one of three groups in 2002-2003. Experimental group I was to receive DOTS case management comprising in-hospital education, direct daily observation in the first two months and one home visit per week. Experimental group II received traditional case management comprising in-hospital education and one home visit per month. The control group did not receive any intervention.
The adherence, the rate of completion, the treatment success, sputum conversion and chest X-ray improvement of experimental group I were significantly improved compared with experimental group II and the control group. The completion rate in experimental group I was higher than the general rate for Taiwan during the past six years and the treatment success rate met the standards of the World Health Organization.
Hospitals using case management with DOTS can improve the adherence of tuberculosis patients and the control of tuberculosis-epidemic situations. Relevance to clinical practice. In a rapidly changing healthcare environment, clinical nurses can make a significant contribution to healthcare delivery for tuberculosis patients. This study has provided further insight into the implementation of hospital-to-community level case management using DOTS by nurses.
探讨台湾地区医院采用病例管理结合直接观察短程治疗法（DOTS）监测肺结核患者依从性的效果。
抗结核化疗的不依从是治疗结核病患者的主要问题。基于社区的病例管理结合DOTS已应用于结核病患者，在一些国家取得了良好效果。台湾地区结核病发病率较高，虽然已实施DOTS，但预期的疗效提升尚未实现。
本研究采用准实验设计。以年龄和性别作为匹配因素，在2002 - 2003年将96名受试者随机分为三组。实验组I接受DOTS病例管理，包括住院教育、前两个月每日直接观察以及每周一次家访。实验组II接受传统病例管理，包括住院教育和每月一次家访。对照组未接受任何干预。
与实验组II和对照组相比，实验组I的依从性、完成率、治疗成功率、痰菌转阴率和胸部X线改善情况均有显著提高。实验组I的完成率高于台湾地区过去六年的总体水平，治疗成功率达到世界卫生组织标准。
医院采用DOTS病例管理可提高肺结核患者的依从性并控制结核病疫情。与临床实践的相关性。在快速变化的医疗环境中，临床护士可为结核病患者的医疗服务做出重大贡献。本研究为护士实施从医院到社区层面的DOTS病例管理提供了进一步的见解。
