Xing Wei, Zhang Rui, Jiang Weixi, Zhang Ting, Pender Michelle, Zhou Jiani, Pu Jie, Liu Shili, Wang Geng, Chen Yong, Li Jin, Hu Daiyu, Tang Shenglan, Li Ying
Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China.
Duke Kunshan University, Kunshan, Jiangsu, People's Republic of China.
Infect Drug Resist. 2021 Mar 15;14:999-1012. doi: 10.2147/IDR.S293583. eCollection 2021.
This paper evaluated the treatment adherence for multidrug-resistant tuberculosis (MDR-TB) and MDR-TB case management (MTCM) in Chongqing, China in order to identify factors associated with poor treatment adherence and case management.
Surveys with 132 MDR-TB patients and six in-depth interviews with health care workers (HCWs) from primary health centers (PHC), doctors from MDR-TB designated hospitals and MDR-TB patients were conducted. Surveys collected demographic and socio-economic characteristics, as well as factors associated with treatment and case management. In-depth interviews gathered information on treatment and case management experience and adherence behaviors.
Patient surveys found the two main reasons for poor adherence were negative side-effects from the treatment and busy work schedules. In-depth interviews with key stakeholders found that self-perceived symptom improvement, negative side-effects from treatment and financial difficulties were the main reasons for poor adherence. MDR-TB patients from urban areas, who were unmarried, were female, had migrant status, and whose treatments were supervised by health care workers from primary health clinics, had poorer treatment adherence (P<0.05). Among the MDR-TB patients surveyed, 86.7% received any type of MTCM in general (received any kind of MTCM from HCWs in PHC, MDR-TB designated hospital and centers of disease control/TB dispensaries and 62.50% received MTCM from HCWs in PHC sectors). Patients from suburban areas were more likely to receive both MTCM in general (OR=6.70) and MTCM from HCWs in MDR-TB designated hospitals (OR=2.77), but female patients (OR=0.26) were less likely to receive MTCM from HCWs in PHC sectors, and patients who were not educated about MTCM by TB doctors in designated hospitals were less likely to receive MTCM in general (OR=0.14). Patients who had not been hospitalized were less likely to receive MTCM from HCWs in MDR-TB designated hospitals (OR=0.21).
Stronger MTCM by HCWs in PHC sectors would improve treatment adherence among MDR-TB patients. Community-based patient-centered models of MTCM in PHC sectors and the use of digital health technology could help to improve case management and thereby improve adherence.
本文评估了中国重庆耐多药结核病（MDR-TB）的治疗依从性及耐多药结核病病例管理（MTCM）情况，以确定与治疗依从性差及病例管理相关的因素。
对132例耐多药结核病患者进行了调查，并对来自基层医疗中心（PHC）的医护人员、耐多药结核病定点医院的医生以及耐多药结核病患者进行了6次深入访谈。调查收集了人口统计学和社会经济特征，以及与治疗和病例管理相关的因素。深入访谈收集了治疗和病例管理经验及依从行为方面的信息。
患者调查发现依从性差的两个主要原因是治疗的负面副作用和繁忙的工作安排。对关键利益相关者的深入访谈发现，自我感觉症状改善、治疗的负面副作用和经济困难是依从性差的主要原因。来自城市地区、未婚、女性、有流动人口身份且其治疗由基层医疗诊所的医护人员监督的耐多药结核病患者，治疗依从性较差（P<0.05）。在接受调查的耐多药结核病患者中，总体上86.7%的患者接受了某种类型的耐多药结核病病例管理（从基层医疗中心、耐多药结核病定点医院和疾病控制中心/结核病防治所的医护人员处接受了任何一种耐多药结核病病例管理），62.50%的患者从基层医疗部门的医护人员处接受了耐多药结核病病例管理。郊区患者更有可能总体上接受耐多药结核病病例管理（OR=6.70）以及从耐多药结核病定点医院的医护人员处接受耐多药结核病病例管理（OR=2.77），但女性患者（OR=0.26）从基层医疗部门的医护人员处接受耐多药结核病病例管理的可能性较小，且在定点医院未接受结核病医生耐多药结核病病例管理教育的患者总体上接受耐多药结核病病例管理的可能性较小（OR=0.14）。未住院的患者从耐多药结核病定点医院的医护人员处接受耐多药结核病病例管理的可能性较小（OR=0.21）。
基层医疗部门的医护人员加强耐多药结核病病例管理将提高耐多药结核病患者的治疗依从性。基层医疗部门以患者为中心的社区耐多药结核病病例管理模式以及数字健康技术的应用有助于改善病例管理，从而提高依从性。
