Division of Respiratory and Critical Care Physiology and Medicine, Harbor-UCLA Medical Center, Torrance, California 90509, USA.
Int J Tuberc Lung Dis. 2011 Jul;15(7):855-61. doi: 10.5588/ijtld.10.0486.
The occurrence of significant drug resistance in many countries, coupled with known problems in delivering directly observed therapy (DOT), calls for a re-examination of tuberculosis (TB) treatment delivery strategies. Electronic medication monitors, devices that determine when medication is removed from containers, and videophone-based strategies are being introduced to determine if they can effectively differentiate 1) patients who are adequately adherent to self-administered treatment (SAT), 2) less reliable patients who could be successfully treated with SAT if given more intensive counseling and 3) patients who require DOT. The adherence record could be used in deciding on compensatory longer treatment when poor adherence occurs. The time saved not giving DOT to all patients could be used to retrieve defaulters. Together these components constitute a monitor-based strategy. The program could be extended to supervise the adherence of private patients to medication provided by trained and subsidized pharmacies with the physicians or, when necessary, health departments managing poorly adherent patients. When patients move, the device could transfer essential data to the new care giver. To obtain optimal results, the requirements for the best possible devices and procedures for dealing with poor adherence need to be carefully evaluated.
在许多国家，药物耐药性的发生率很高，加上直接观察治疗（DOT）方面存在已知问题，这就要求重新审查结核病（TB）治疗的提供策略。正在引入电子药物监测器、确定药物何时从容器中取出的设备以及基于可视电话的策略，以确定它们是否能够有效地区分以下三种患者：1）能够充分遵守自我管理治疗（SAT）的患者；2）如果给予更强化的咨询，可以成功治疗的不太可靠的患者；3）需要 DOT 的患者。可以根据服药不依从时的记录，决定是否给予更长的补偿性治疗。将 DOT 不给所有患者节省下来的时间可以用于追回失访者。这些组成部分共同构成了基于监测的策略。该计划可以扩展到监督私人患者对经过培训和补贴的药房提供的药物的依从性，医生或必要时，卫生部门管理服药不依从的患者。当患者移动时，该设备可以将重要数据转移给新的护理提供者。为了获得最佳效果，需要仔细评估处理不依从性的最佳设备和程序的要求。
