de Vries Gerard, Tsolova Svetla, Anderson Laura F, Gebhard Agnes C, Heldal Einar, Hollo Vahur, Cejudo Laura Sánchez-Cambronero, Schmid Daniela, Schreuder Bert, Varleva Tonka, van der Werf Marieke J
KNCV Tuberculosis Foundation, The Hague, The Netherlands.
European Centre for Disease Prevention and Control, Tomtebodavagen 11A, S-171 83, Stockholm, Sweden.
BMC Public Health. 2017 Apr 19;17(1):334. doi: 10.1186/s12889-017-4216-9.
In the European Union and European Economic Area only 38% of multidrug-resistant tuberculosis patients notified in 2011 completed treatment successfully at 24 months' evaluation. Socio-economic factors and patient factors such as demographic characteristics, behaviour and attitudes are associated with treatment outcomes. Characteristics of healthcare systems also affect health outcomes. This study was conducted to identify and better understand the contribution of health system components to successful treatment of multidrug-resistant tuberculosis.
We selected four European Union countries to provide for a broad range of geographical locations and levels of treatment success rates of the multidrug-resistant tuberculosis cohort in 2009. We conducted semi-structured interviews following a conceptual framework with representatives from policy and planning authorities, healthcare providers and civil society organisations. Responses were organised according to the six building blocks of the World Health Organization health systems framework.
In the four included countries, Austria, Bulgaria, Spain, and the United Kingdom, the following healthcare system factors were perceived as key to achieving good treatment results for patients with multidrug-resistant tuberculosis: timely diagnosis of drug-resistant tuberculosis; financial systems that ensure access to a full course of treatment and support for multidrug-resistant tuberculosis patients; patient-centred approaches with strong intersectoral collaboration that address patients' emotional and social needs; motivated and dedicated healthcare workers with sufficient mandate and means to support patients; and cross-border management of multidrug-resistant tuberculosis to secure continuum of care between countries.
We suggest that the following actions may improve the success of treatment for multidrug-resistant tuberculosis patients: deployment of rapid molecular diagnostic tests; development of context-specific treatment guidance and criteria for hospital admission and discharge in the European context; strengthening patient-centred approaches; development of collaborative mechanisms to ensure cross-border care, and development of long-term sustainable financing strategies.
在欧盟和欧洲经济区，2011年报告的耐多药结核病患者中只有38%在24个月评估时成功完成治疗。社会经济因素以及患者因素，如人口统计学特征、行为和态度，与治疗结果相关。医疗保健系统的特征也会影响健康结果。开展本研究是为了确定并更好地理解卫生系统各组成部分对耐多药结核病成功治疗的贡献。
我们选择了四个欧盟国家，以涵盖广泛的地理位置以及2009年耐多药结核病人群的不同治疗成功率水平。我们按照一个概念框架，对来自政策和规划当局、医疗服务提供者以及民间社会组织的代表进行了半结构化访谈。根据世界卫生组织卫生系统框架的六个组成部分对回答进行了整理。
在纳入研究的四个国家，奥地利、保加利亚、西班牙和英国，以下医疗保健系统因素被视为耐多药结核病患者取得良好治疗效果的关键：耐多药结核病的及时诊断；确保获得全程治疗以及为耐多药结核病患者提供支持的金融体系；以患者为中心且跨部门协作紧密、能满足患者情感和社会需求的方法；积极且敬业、有足够权力和手段支持患者的医护人员；以及耐多药结核病的跨境管理，以确保各国之间的连续护理。
我们建议，以下行动可能会提高耐多药结核病患者的治疗成功率：采用快速分子诊断检测；制定针对欧洲情况的具体治疗指南以及医院出入院标准；加强以患者为中心的方法；建立确保跨境护理的协作机制，以及制定长期可持续的融资策略。
