移动语音通话对本地一家三级医院肺结核患者治疗启动的影响：一项随机对照试验。
Effect of mobile voice calls on treatment initiation among patients diagnosed with tuberculosis in a tertiary care hospital of Puducherry: A randomized controlled trial.
机构信息
Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Tamil Nadu, India.
Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.
出版信息
J Postgrad Med. 2021 Oct-Dec;67(4):205-212. doi: 10.4103/jpgm.JPGM_1105_20.
OBJECTIVE
In India, about one third of tuberculosis (TB) patients diagnosed at tertiary hospitals are missed during a referral to peripheral health institutes for treatment. To address this, we assessed whether mobile voice call reminders to TB patients after diagnosis at a tertiary hospital decrease the proportion of "pretreatment loss to follow-up" (PTLFU), compared with the conventional paper-based referral.
DESIGN
A two-group parallel-arm randomized controlled trial was conducted.
SETTING
The study was conducted in a tertiary care hospital at Puducherry, South India.
PARTICIPANTS
All newly diagnosed TB patients, both pulmonary and extrapulmonary, who were referred for treatment from the selected tertiary care hospital and possessed a mobile phone were eligible to participate. The participants were enrolled between March 2015 and June 2016 and were randomized to study groups using the block randomization with allocation concealment.
INTERVENTION
The participants in the intervention arm received standardized mobile voice calls reminding them to register for anti-TB treatment on the second and seventh day after referral in addition to the conventional paper-based referral received by the control group.
PRIMARY OUTCOMES
Patients not started on anti-TB treatment within 14 days of referral were considered as PTLFU. The outcome of PTLFU was ascertained through phone calls made on the 14 day after referral. The intention-to-treat analysis was used, and the proportion of PTLFU in the study groups and the risk difference with 95% confidence interval (CI) were calculated.
RESULTS
Of the 393 patients assessed for eligibility, 310 were randomized to the intervention (n = 155) and control (n = 155) arms. In the intervention arm, 14 (9%) out of 155 were PTLFU compared with 28 (18%) of the 155 patients in the control arm. The absolute risk difference was 9% (95% CI [1.5, 16.6], P = 0.01).
CONCLUSION
Mobile voice call reminder to patients is a feasible intervention and can reduce PTLFU among referred TB patients.
目的
在印度，约有三分之一在 tertiary hospitals 诊断出的结核病 (TB) 患者在转诊至基层卫生机构接受治疗时被漏诊。为了解决这一问题，我们评估了在 tertiary hospital 诊断出结核病后，通过移动语音电话提醒患者，与传统的纸质转诊相比，是否能降低“治疗前失访”（PTLFU）的比例。
设计
采用两组平行臂随机对照试验。
地点
该研究在印度南部 Puducherry 的一家三级护理医院进行。
参与者
所有新诊断为肺结核和肺外结核、被转诊至选定的三级护理医院且拥有移动电话的患者均有资格参加。参与者于 2015 年 3 月至 2016 年 6 月期间招募，并使用带有分配隐藏的块随机化进行分组。
干预措施
干预组的参与者除了接受对照组收到的传统纸质转诊外，还在转诊后的第二天和第七天收到标准化的移动语音电话提醒他们注册接受抗结核治疗。
主要结局
在转诊后 14 天内未开始接受抗结核治疗的患者被视为 PTLFU。通过在转诊后第 14 天进行电话随访来确定 PTLFU 的结果。采用意向治疗分析，计算研究组的 PTLFU 比例以及风险差异和 95%置信区间（CI）。
结果
在评估合格性的 393 名患者中，有 310 名被随机分配至干预组（n = 155）和对照组（n = 155）。在干预组中，有 14 名（9%）患者是 PTLFU，而对照组中有 28 名（18%）患者是 PTLFU。绝对风险差异为 9%（95%CI[1.5，16.6]，P = 0.01）。
结论
向患者发送移动语音电话提醒是一种可行的干预措施，可以降低转诊的结核病患者的 PTLFU。
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