Izudi Jonathan, Tamwesigire Imelda K, Bajunirwe Francis
Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda.
IJID Reg. 2024 Sep 24;13:100461. doi: 10.1016/j.ijregi.2024.100461. eCollection 2024 Dec.
Missed clinic visits disrupt the continuity of care and potentially impact tuberculosis (TB) treatment outcomes negatively. We evaluated the effect of missed clinic visits on mortality and treatment success among people with bacteriologically confirmed pulmonary TB in rural eastern Uganda.
Using routine TB clinic data, we designed a quasi-experimental study and used instrumental variable analysis to estimate a cause-effect. The exposure was one or more missed clinic visit(s), the instrumental variable was patient residence in the same sub-county as the TB clinic, and the outcomes were mortality and treatment success. We performed a two-stage least squares logistic regression for causal analysis and reported the odds ratio (OR) and 95% confidence interval (CI).
Of 762 participants with similar baseline characteristics, 186 (24.4%) missed ≥1 clinic visit(s), 342 (44.9%) resided in the same sub-county as the TB clinic, 61 (8.0%) had died, and 687 (90.2%) were successfully treated for TB. Missed clinic visits increased mortality (OR 2.88, 95% CI 1.36-6.13) and reduced TB treatment success (OR 0.41, 95% CI 0.20-0.82).
Missed clinic visits increase mortality and negatively impact treatment success among people with TB. The reasons for missed clinic visits should be identified and tackled through context-specific measures.
错过门诊就诊会破坏治疗的连续性，并可能对结核病（TB）治疗结果产生负面影响。我们评估了在乌干达东部农村地区，错过门诊就诊对细菌学确诊的肺结核患者死亡率和治疗成功率的影响。
利用结核病门诊常规数据，我们设计了一项准实验研究，并使用工具变量分析来估计因果关系。暴露因素为一次或多次错过门诊就诊，工具变量为患者与结核病门诊位于同一子县，结果指标为死亡率和治疗成功率。我们进行了两阶段最小二乘逻辑回归以进行因果分析，并报告了比值比（OR）和95%置信区间（CI）。
在762名具有相似基线特征的参与者中，186人（24.4%）错过≥1次门诊就诊，342人（44.9%）与结核病门诊位于同一子县，61人（8.0%）死亡，687人（90.2%）结核病治疗成功。错过门诊就诊会增加死亡率（OR 2.88，95%CI 1.36 - 6.13）并降低结核病治疗成功率（OR 0.41，95%CI 0.20 - 0.82）。
错过门诊就诊会增加结核病患者的死亡率，并对治疗成功率产生负面影响。应通过针对性措施找出错过门诊就诊的原因并加以解决。
