Unitat Clínica de Tuberculosis, Hospital del Mar, Barcelona, Spain.
Servicio de Epidemiología, Agència de Salut Pública de Barcelona, Barcelona, Spain.
Arch Bronconeumol (Engl Ed). 2021 May;57(5):330-337. doi: 10.1016/j.arbres.2020.05.025. Epub 2020 Jun 24.
Since there are active drugs against tuberculosis (TB), the most effective control measures are to assure treatment adherence and to perform contact tracing. Given the long treatment duration and characteristics of some TB patients, threats that put at risk treatment adherence may appear. Identify and address them is essential to achieve the objectives of disease control.
To identify the epidemiological characteristics of TB patients and the incidents and threats occurring during treatment, to describe the interventions performed to enhance treatment adherence and to determine if there are differences among native and foreign-born patients in the TB clinical unit of a referral hospital in the inner city of Barcelona.
A descriptive, observational, cross-sectional study was performed. We recorded information on sociodemographic and clinical characteristics, incidents and interventions during treatment in all patients with TB diagnosed between September 2013 and August 2016.
172 patients were included, 62.2% were foreign-born. The most common incidents and threats were medication-related complications (43.0%), missed follow-up visits (34.3%), communication problems (25.6%), comorbidities complications (23.8%), trips (19.2%), fear of social rejection (16.9%) and change of address (14.5%). The adherence-promoting interventions were: follow-up calls, directly observed treatment, medical and humanitarian reports, extra visits and cultural mediation. Incidents and interventions were more frequent in foreign-born patients, however there were no differences in treatment success among Spanish and foreign-born.
In this inner city several incidents occurred during TB treatment that can threaten adherence and are more common among foreign-born patients. Coordination among professionals from different healthcare settings was able to overcome obstacles in most cases and achieve TB treatment completion.
由于存在针对结核病 (TB) 的有效药物，最有效的控制措施是确保治疗依从性并进行接触者追踪。鉴于治疗时间长和某些 TB 患者的特点，可能会出现影响治疗依从性的威胁。识别和解决这些威胁对于实现疾病控制目标至关重要。
确定 TB 患者的流行病学特征以及治疗期间发生的事件和威胁，描述为提高治疗依从性而采取的干预措施，并确定在巴塞罗那市中心转诊医院的 TB 临床科室中，本地和外国出生的患者之间是否存在差异。
我们进行了一项描述性、观察性、横断面研究。我们记录了 2013 年 9 月至 2016 年 8 月期间所有诊断为 TB 的患者的社会人口学和临床特征、治疗期间发生的事件和干预措施的信息。
共纳入 172 例患者，其中 62.2%为外国出生。最常见的事件和威胁是药物相关并发症（43.0%）、错过随访（34.3%）、沟通问题（25.6%）、合并症并发症（23.8%）、旅行（19.2%）、害怕社会排斥（16.9%）和地址变更（14.5%）。促进治疗依从性的干预措施包括：随访电话、直接观察治疗、医疗和人道主义报告、额外就诊和文化调解。外国出生患者的事件和干预措施更为常见，但西班牙和外国出生患者的治疗成功率无差异。
在这个市中心，TB 治疗期间发生了一些可能威胁治疗依从性的事件，而且在外国出生患者中更为常见。来自不同医疗保健机构的专业人员之间的协调能够克服大多数情况下的障碍，从而完成 TB 治疗。
