New York University School of Medicine, New York, NY; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Chest. 2014 Jan;145(1):95-100. doi: 10.1378/chest.13-0324.
One of the most controversial aspects of New York City's highly effective TB control program is the use of public health law and court-ordered detention to treat persistently recalcitrant patients with active TB. We now report on characteristics and outcomes of patients undergoing detention for completion of TB treatment due to nonadherence in New York City from 2002 through 2009.
A retrospective cohort study was designed to compare patients undergoing court-ordered detention (n = 79) and time-matched control subjects undergoing TB treatment in outpatient directly observed therapy (DOT) at Bellevue Hospital in New York City.
From January 1, 2002, through December 31, 2009, 79 patients underwent court-ordered detention for TB treatment. Compared with patients completing treatment in DOT, univariate analysis found that detainees were younger; more likely to be of minority race/ethnicity; to have a history of substance abuse, tobacco use, homelessness, incarceration, HIV infection; and to be born in the United States. Multivariate analysis adjusting for other variables found smear positivity (OR = 3.93; 95% CI, 1.05-14.75; P = .04), mental illness (OR = 5.80; 95% CI, 1.18-28.51; P = .03), and substance abuse (OR = 9.25; 95% CI, 2.81-30.39; P < .01) to be the strongest independent predictors of likelihood of detention. Of those initially detained, 46 (58%) completed treatment during inpatient detention, 29(37%) completed treatment under outpatient court-ordered DOT, and four died during their hospitalization.
The majority of patients undergoing court-ordered detention for TB treatment (95%) successfully completed therapy. Likelihood of detention was most strongly associated with factors expected to be associated with poor adherence, including mental illness and substance abuse.
纽约市高效结核病控制项目最具争议的方面之一是利用公共卫生法和法庭命令拘留来治疗顽固不化的活动性肺结核患者。我们现在报告 2002 年至 2009 年期间因不遵医嘱而在纽约市接受拘留以完成结核病治疗的患者的特征和结局。
设计了一项回顾性队列研究，以比较因不遵医嘱而在纽约市贝尔维尤医院接受法庭命令拘留（n=79）和接受门诊直接观察治疗（DOT）的时间匹配对照患者（n=79）。
从 2002 年 1 月 1 日至 2009 年 12 月 31 日，79 名患者因结核病治疗而被法庭命令拘留。与在 DOT 中完成治疗的患者相比，单变量分析发现被拘留者更年轻；更有可能是少数民族；有滥用药物、吸烟、无家可归、监禁、感染艾滋病毒的病史；并且出生在美国。调整其他变量的多变量分析发现，涂片阳性（OR=3.93；95%CI，1.05-14.75；P=0.04）、精神疾病（OR=5.80；95%CI，1.18-28.51；P=0.03）和药物滥用（OR=9.25；95%CI，2.81-30.39；P<0.01）是被拘留的最强独立预测因素。最初被拘留的 46 人（58%）在住院期间完成了治疗，29 人（37%）在门诊法庭命令 DOT 下完成了治疗，4 人在住院期间死亡。
大多数因结核病治疗而被法庭命令拘留的患者（95%）成功完成了治疗。被拘留的可能性与预期与不遵医嘱相关的因素密切相关，包括精神疾病和药物滥用。
