越南农村地区诊断为药物敏感型肺结核的患者中药物提醒监测器的实施：一项定性研究。
Implementation of Medication Event Reminder Monitors among patients diagnosed with drug susceptible tuberculosis in rural Viet Nam: A qualitative study.
机构信息
Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia.
出版信息
PLoS One. 2019 Jul 22;14(7):e0219891. doi: 10.1371/journal.pone.0219891. eCollection 2019.
BACKGROUND
Despite the criticality of adherence to tuberculosis treatment, there is paucity of rigorous experimental research exploring the efficacy of interventions to promote adherence and a greater lack of inquiry addressing the integral role of adherence behaviour. The aim of this formative study was to examine the way in which the Wisepill evriMED Medication Event Reminder Monitor (MERM) was used among outpatients with drug susceptible pulmonary tuberculosis.
METHODS
In depth interviews were conducted with 20 outpatients receiving treatment from two public healthcare facilities in Thanh Hoa, a rural province in northern Viet Nam. Patients had been enrolled in a randomized controlled trial evaluating the effect of using the MERM device upon adherence for between 1-3 months. The control group used the device without an alert, while the intervention group used the device with a daily alert and scheduled dosing history review.
FINDINGS
All 20 patients interviewed were supportive of using the MERM device. Those able to be at home at the time that their treatment was due (50%) used the device as intended. Patients who worked all reported separating the time when the box was opened from the time at which they ingested their medication. Patients expressed fidelity to the prescribed medication taking time and concerns regarding the portability of the device. Limitations of the study surround the inclusion of a small sample population that did not experience factors that further compromise adherence.
CONCLUSIONS
Data recorded by the box did not always accurately reflect usage patterns. The alert in the intervention arm was able to support adherence only in patients who did not work while completing their treatment. MERM implementation can be improved by better aligning prescriber instructions with patients' daily routines, and increasing the use of adherence data to guide adherence support practices. Healthcare staff need to be aware of potential barriers to optimal use of MERM devices. A rigorous qualitative approach to formative assessment is essential to inform the scale up of new digital technologies.
背景
尽管结核病治疗的依从性至关重要，但缺乏严格的实验研究来探索促进依从性的干预措施的效果，更缺乏对依从性行为的整体作用的探究。本形成性研究旨在考察 Wisepill evriMED 药物事件提醒监测器（MERM）在耐多药肺结核门诊患者中的使用方式。
方法
对来自越南北部清化省两家公立医疗机构的 20 名接受治疗的门诊患者进行深入访谈。这些患者参加了一项随机对照试验，评估使用 MERM 设备对依从性的影响，使用时间为 1-3 个月。对照组在没有警报的情况下使用该设备，而干预组则在使用设备时带有每日警报和预定的剂量历史记录审查。
发现
所有接受访谈的 20 名患者都支持使用 MERM 设备。有 50%的患者能够在其治疗时间在家中时按预期使用该设备。所有工作的患者都报告说将打开药盒的时间与服药时间分开。患者对按时服用规定药物表示忠诚，并对设备的便携性表示关注。研究的局限性在于纳入的样本量较小，且未经历进一步影响依从性的因素。
结论
盒子记录的数据并不总是准确反映使用模式。干预组中的警报仅在治疗期间不工作的患者中能够支持依从性。通过更好地将处方说明与患者的日常工作流程相匹配，并增加对依从性数据的使用来指导依从性支持实践，可以改进 MERM 的实施。医疗保健人员需要了解优化使用 MERM 设备的潜在障碍。采用严格的定性方法进行形成性评估对于新数字技术的推广至关重要。
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