对涂阳肺结核病人实施直接面视下服药影响因素定性研究

QUALITATIVE STUDY ON INFLUENCIAL FACTORS TO DIRECTLY OBSERVED THERAPY TO SPUTUM SMEAR POSITIVE TB PATIENTS BY HEALTH WORKERS.

目的:评价重庆市医务人员对涂阳肺结核病人实施直接面视下服药管理的执行情况,找出影响其实施的因素,为今后促进重庆地区的结核病人管理工作提供科学的依据。方法:采用定性研究,对有代表性的4个县的63人,包括县级分管领导,县乡村各级医务人员及涂阳结核病人等进行了关键人物访谈和个人深入访谈。结果:多数结核病人吃药时没有医务人员监督。影响这一管理方式实施的因素包括:医生和病人认为没有必要执行DOT;村医督导病人缺乏有效的激励机制,病人担心受到社会歧视而拒绝接受督导等等。结论:重庆市DOT的执行没有达到国家规划指南的要求,在实际的实施过程中面临了很多的困难。应该针对病人的具体情况及当地的社会经济发展状况来制定切实可行的病人管理模式,以促进结核病控制工作的可持续发展。

Objective： To evaluate the current sitUation of DOT implementation, and explore possible influential factors, thus provide evidence to improve TB cases management in Chongqing dty. Methods： Qualitative method was applied and county corresponding leaders, TB doctors at different levels and current treated TB patients （63 in total） were in- depth interviewed. Results： Most TB patients take durgs without supervision by health workers. The influential factors include： the doctors and patients think it＇ s no necessary to implement DOT, there isn＇t effective incentive for village doctor to conduct DOT, patients reject DOT for fearing of social stigma etc. Conclusion. DOT has not well implemented in Chongqing. Patients management should consider patients＇ situation and the local social and economic context.