印度德里地区移动医疗干预对结核药物治疗依从性的影响：一项准实验研究。

The effect of a mhealth intervention on anti-tuberculosis medication adherence in Delhi, India: A quasi-experimental study.

机构信息

Junior Resident, Department of Community Medicine, Maulana Azad Medical College, New Delhi, India.

Director Professor, Department of Community Medicine, Maulana Azad Medical College, New Delhi, India.

出版信息

Indian J Public Health. 2021 Jan-Mar;65(1):34-38. doi: 10.4103/ijph.IJPH_879_20.

DOI:10.4103/ijph.IJPH_879_20

PMID:33753687

Abstract

BACKGROUND

Suboptimal adherence to anti-tuberculosis medication in patients is associated with adverse treatment outcomes including treatment failure, relapse, and emergence of drug resistance.

OBJECTIVES

: We conducted the present study with the objectives of evaluating the effectiveness of a mHealth package on the medication adherence of patients with tuberculosis (TB) on antitubercular (directly observed treatment short-course [DOTS]) treatment.

METHODS

We conducted Quasi-experimental study at six DOTS centers of Delhi among 220 newly diagnosed TB patients. We included adult TB patients (18 years and above) who were on DOTS therapy ≥30 days, had access to a mobile phone and were able to read messages and receive calls. We excluded patients with impaired hearing, blindness and those on non-DOTS therapy or having multidrug-resistant/extensively drug-resistant TB. Participants in the intervention group received amHealth package for 90 days. The medication adherence of the study participants was measured using Morisky, Green, and Levine Adherence Scale.

RESULTS

A total of 130 men and 90 women were recruited for the study. Occupational interference and forgetfulness were the most common reasons for medication nonadherence in the patients. In the intervention group, the medication adherence to antitubercular medication (daily DOTS regimen) was 85.5% at baseline which increased to 96.4% at endline (postintervention) (P = 0.004). No significant change was observed in the control group (P = 0.328). The increase in adherence was observed across the following subgroups: age, gender, education, and Socioeconomic status.

CONCLUSIONS

The mHealth intervention in TB patients was effective in improving the adherence to DOTS therapy.

摘要

背景

患者抗结核药物治疗依从性差与治疗失败、复发和耐药性的出现等不良治疗结局有关。

目的

我们进行本项研究，旨在评估移动医疗（mHealth）方案对接受直接观察短期疗程（DOTS）治疗的结核病（TB）患者药物依从性的影响。

方法

我们在德里的六个 DOTS 中心开展了一项准实验研究，纳入了 220 名新诊断的 TB 患者。纳入标准为：年龄≥18 岁；接受 DOTS 治疗≥30 天；有移动电话，能够阅读短信和接听电话；排除听力受损、失明的患者，排除接受非 DOTS 治疗或患有耐多药/广泛耐药结核病的患者。干预组患者接受 mHealth 方案治疗 90 天。使用 Morisky、Green 和 Levine 药物依从性量表评估研究参与者的药物依从性。

结果

共招募到 130 名男性和 90 名女性患者。药物不依从的最常见原因是职业干扰和健忘。干预组患者的抗结核药物（每日 DOTS 方案）依从性在基线时为 85.5%，在干预结束时（即干预后）增加至 96.4%（P=0.004）。对照组无显著变化（P=0.328）。依从性的增加在以下亚组中观察到：年龄、性别、教育程度和社会经济地位。