Arif K, Ali S A, Amanullah S, Siddiqui I, Khan J A, Nayani P
Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
Int J Tuberc Lung Dis. 1998 Mar;2(3):225-30.
The Aga Khan University Hospital, in Karachi, Pakistan, is a 650-bed university teaching hospital.
There is little data from Pakistan on the awareness and application of the World Health Organization (WHO)'s tuberculosis treatment guidelines among physicians. This study evaluates physician compliance with these guidelines.
A questionnaire to measure physician compliance was developed, pilot tested and standardised. Case records of all patients hospitalized with tuberculosis were reviewed (January-December 1995, n = 229), and were classified into WHO Category 1 (n = 191), Category 2 (n = 9) and Category 3 (n = 29).
A total of 53 (23%) patients had a diagnostic bacteriological sputum smear examination, of which 38% were smear positive and 47% culture positive. Of 25 cerebrospinal fluid cultures 12% were positive. No sputum smear tests were conducted during treatment. Of 58 patients in Category 1 who completed therapy 74% received a 2-month intensive phase consisting of HRZE (isoniazid, rifampicin, pyrazinamide, ethambutol) (n = 43), while 41% received a 6 month continuation phase with HE (n = 24). Over 70% patients were lost to follow up, more than half of these during the intensive phase.
Our study reflects poor awareness of the WHO guidelines and low compliance among physicians, and a high loss to follow-up. Efforts are needed to create physician awareness about the WHO guidelines and their use. This study can be used to assess the effectiveness of any future physician education and to identify areas of weakness in health care.
位于巴基斯坦卡拉奇的阿迦汗大学医院是一家拥有650张床位的大学教学医院。
在巴基斯坦，关于医生对世界卫生组织（WHO）结核病治疗指南的知晓和应用的数据很少。本研究评估医生对这些指南的依从性。
开发了一份用于衡量医生依从性的问卷，进行了预试验并标准化。回顾了所有因结核病住院患者的病例记录（1995年1月至12月，n = 229），并将其分为WHO第1类（n = 191）、第2类（n = 9）和第3类（n = 29）。
共有53名（23%）患者进行了诊断性痰涂片细菌学检查，其中38%为涂片阳性，47%为培养阳性。25份脑脊液培养中有12%为阳性。治疗期间未进行痰涂片检查。在完成治疗的58名第1类患者中，74%接受了为期2个月的强化期治疗，包括HRZE（异烟肼、利福平、吡嗪酰胺、乙胺丁醇）（n = 43），而41%接受了为期6个月的继续期治疗，使用HE（n = 24）。超过70%的患者失访，其中一半以上是在强化期失访的。
我们的研究反映出医生对WHO指南的知晓度低、依从性差，以及失访率高。需要努力提高医生对WHO指南及其用途的认识。本研究可用于评估未来任何医生教育的效果，并确定医疗保健中的薄弱环节。
