以家庭为基础的护理作为提高耐多药结核病治疗效率的一种方法：一项准实验性试点研究。
Home Based Care as an Approach to Improve the Efficiency of treatment for MDR Tuberculosis: A Quasi-Experimental Pilot Study.
作者信息
Taneja Neha, Chellaiyan Vinoth Gnana, Daral Shailaja, Adhikary Mrinmoy, Das Timiresh Kumar
机构信息
Senior Resident, Department of Community Medicine, NDMC Medical College and Hindu Rao Hospital, Delhi, India.
Assistant Professor, Department of Community Medicine, Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India.
出版信息
J Clin Diagn Res. 2017 Aug;11(8):LC05-LC08. doi: 10.7860/JCDR/2017/27594.10401. Epub 2017 Aug 1.
INTRODUCTION
Multi Drug Resistant Tuberculosis (MDR TB) has emerged as a significant public health problem in India. The prolonged treatment duration in MDR TB is a challenge in achieving treatment completion and poses a threat to TB control in the country. Home based care is an approach accepted by patients because it helps in ameliorating their understanding of TB, improving the compliance and reducing stigma in the community.
AIM
To assess the outcome of Home-Based Care (HC) versus No Home-Based Care (NHC) on the treatment of MDR TB patients registered at two chest clinics in Eastern Delhi.
MATERIALS AND METHODS
A quasi-experimental study was done among diagnosed MDR TB patients receiving Category IV regimen under Revised National Tuberculosis Control Programme (RNTCP) from two government chest clinics in Eastern Delhi during May 2014 to May 2016. In the control arm, 50 MDR TB patients at one of the chest clinics were offered the standard Category IV regimen under RNTCP; while in the intervention arm, 50 MDR TB patients at the second chest clinic were provided home based care (counselling, support for completion of treatment, rehabilitation, and nutritional support) along with the standard treatment. The primary outcome assessed was outcome of treatment, while secondary outcomes included stigma faced due to the disease, and impact of disease on family and community life.
RESULTS
The primary outcome data was available for 32 (64%) participants in the intervention arm, and 38 (76%) participants in control arm. The treatment was significantly more successful in the intervention arm (p<0.03). The data on secondary outcomes was available for all participants. Stigma due to disease was significantly lower in the intervention arm (p<0.01); also rejection faced by participants from family and community due to disease was significantly lower among the HC group (p<0.05).
CONCLUSION
Home-based care in MDR TB treatment holds potential in improving treatment outcomes of patient.
引言
耐多药结核病（MDR TB）已成为印度一个重大的公共卫生问题。耐多药结核病的治疗周期延长，这对完成治疗构成挑战，并对该国的结核病控制构成威胁。居家护理是一种患者能够接受的方式，因为它有助于增进患者对结核病的了解、提高依从性并减少社区中的污名化现象。
目的
评估居家护理（HC）与无居家护理（NHC）对在东德里两家胸部诊所登记的耐多药结核病患者治疗效果的影响。
材料与方法
2014年5月至2016年5月期间，在东德里两家政府胸部诊所对接受修订后的国家结核病控制规划（RNTCP）第四类方案治疗的确诊耐多药结核病患者进行了一项准实验研究。在对照组中，一家胸部诊所的50名耐多药结核病患者接受RNTCP的标准第四类方案治疗；而在干预组中，另一家胸部诊所的50名耐多药结核病患者在接受标准治疗的同时还接受居家护理（咨询、支持完成治疗、康复和营养支持）。评估的主要结果是治疗效果，次要结果包括因该疾病面临的污名化以及疾病对家庭和社区生活的影响。
结果
干预组有32名（64%）参与者和对照组有38名（76%）参与者可获得主要结果数据。干预组的治疗成功率显著更高（p<0.03）。所有参与者均可获得次要结果数据。干预组因疾病产生的污名化现象显著更低（p<0.01）；此外，居家护理组中参与者因疾病受到家庭和社区排斥的情况也显著更低（p<0.05）。
结论
耐多药结核病治疗中的居家护理在改善患者治疗效果方面具有潜力。
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