Schluger N, Ciotoli C, Cohen D, Johnson H, Rom W N
Bellevue Chest Service, New York University Medical Center, New York, USA.
Am J Respir Crit Care Med. 1995 May;151(5):1486-90. doi: 10.1164/ajrccm.151.5.7735604.
The current tuberculosis epidemic in the United States is marked, in many areas, by high rates of noncompliance with antituberculous regimens. In response to this, a comprehensive program of medical, nursing, social services, and supervised therapy was developed at Bellevue Hospital. Most patients were referred to the on-site directly observed therapy program (DOT) located in the hospital. Patients on DOT received daily or twice weekly therapy, and were given incentives to enhance compliance. Outreach was used to track patients who missed appointments. From November 1992 through July 1993, 113 patients were referred. HIV infection, homelessness, illicit drug use, and alcoholism were common. Follow-up revealed that 11 patients were noncompliant and completely lost to follow-up; of the remaining 102, 99% achieved bacteriologic cure. Of the 102 patients who received therapy, 74 attended the Bellevue DOT clinic, 16 attended other DOT programs in the city or received medication at home, and three died of HIV-related, nontuberculous illness. Nine patients were self-medicated and judged treatment successes. We conclude that a comprehensive hospital-based tuberculosis control program is capable of achieving a high degree of success, even in a population at high risk for noncompliance.
美国当前的结核病疫情在许多地区的特点是抗结核治疗方案的依从率很低。针对这一情况，贝尔维尤医院制定了一个包含医疗、护理、社会服务及监督治疗的综合项目。大多数患者被转介到医院内的现场直接观察治疗项目（DOT）。参加DOT的患者接受每日或每周两次的治疗，并给予激励措施以提高依从性。通过外展服务追踪错过预约的患者。从1992年11月到1993年7月，共转介了113名患者。艾滋病毒感染、无家可归、非法药物使用和酗酒情况很常见。随访发现，11名患者不依从且完全失去随访；其余102名患者中，99%实现了细菌学治愈。在接受治疗的102名患者中，74人前往贝尔维尤DOT诊所就诊，16人参加了市内其他DOT项目或在家中接受药物治疗，3人死于与艾滋病毒相关的非结核性疾病。9名患者自行用药，被判定治疗成功。我们得出结论，即使在依从性低风险较高的人群中，基于医院的综合结核病控制项目也能够取得高度成功。
