Medical School, University of East Anglia, Norwich, UK.
Int J Tuberc Lung Dis. 2010 Mar;14(3):311-7.
Public sector primary care clinics in Free State Province, South Africa.
To investigate the effects of on-site in-service clinical skills training for nurse practitioners on tuberculosis (TB) treatment outcomes in the same clinics.
Analysis of TB programme data from clinics taking part in two consecutive randomised trials of educational outreach aimed at improving respiratory and human immunodeficiency virus/acquired immune-deficiency syndrome care based on the Practical Approach to Lung Health. We compared treatment outcomes between control and intervention clinics among all patients diagnosed with TB during either trial.
During the two trials, participating clinics treated 4187 and 2333 TB patients, respectively. Neither intervention was associated with better outcomes overall. However, among retreatment patients, cure or completion rates in intervention clinics were significantly higher during the second trial (OR 1.78, 95%CI 1.13-2.76). Patients in clinics that had received both interventions had higher cure or completion rates (OR 1.99, 95%CI 1.53-2.58) and lower default rates (OR 0.25, 95%CI 0.097-0.63) than patients in clinics that had received neither intervention.
Although not primarily focused on TB treatment, the interventions appeared to improve successful treatment completion rates among TB retreatment cases. Integrated care programmes support attainment of important TB programme goals.
南非自由州省公立基层医疗诊所。
调查现场在职临床技能培训对同诊所有关结核病（TB）治疗结果的影响。
对参与两项连续随机试验的诊所的 TB 项目数据进行分析，这两项试验旨在基于实用肺部健康方法，通过教育推广来改善呼吸道和人类免疫缺陷病毒/获得性免疫缺陷综合征护理。我们比较了在两次试验中所有被诊断为 TB 的患者在对照组和干预组的治疗结果。
在两次试验中，参与的诊所分别治疗了 4187 名和 2333 名 TB 患者。两次干预均与总体结果无明显关联。然而，在复治患者中，干预组在第二次试验中的治愈率或完成率显著更高（比值比 1.78，95%置信区间 1.13-2.76）。接受了两次干预的诊所的患者，其治愈率或完成率更高（比值比 1.99，95%置信区间 1.53-2.58），而失访率更低（比值比 0.25，95%置信区间 0.097-0.63），而那些仅接受了一次干预的诊所的患者则没有这种情况。
尽管干预措施并非主要针对 TB 治疗，但似乎提高了复治 TB 病例的成功治疗完成率。综合护理方案有助于实现 TB 项目的重要目标。
