山东省和浙江省耐药结核患者社区管理现状调查研究

Community-based management of patients with drug-resistant tuberculosis in Shandong and Zhejiang province

目的了解耐药结核患者当前的社区管理现状及不足,分析服药依从与患者所接受的管理情况之间的关系,并提出完善我国耐药结核社区管理模式的建议。方法本研究自制调查问卷在山东省、浙江省的9个地市开展调研,共调查276例2018年1~12月确诊患者的基本情况、服药依从情况和社区管理情况;同时通过访谈从医患双方角度了解社区管理的实施情况及存在的问题。结果服药依从性较好的患者占60.15%,通过进一步分析得出依从性较好的患者更多的接受了规范的社区管理,安排服药督导员(43.67%)和接受社区随访(86.71%)的比例高于依从性较差的患者(P<0.05)。调查地区存在社区管理不能按照指南要求落实,而这与患者配合程度差以及目前社区防保医生的防控能力待提高有关。结论完善的社区管理可以直接影响耐药结核患者的服药依从情况,但目前调查地区未能严格落实社区管理模式,建议政府进一步加大专项财政投入和配套支持,提升社区管理医疗和服务能力。

Objective To understand the implementation and challenges of community-based management of patients with drug-resistant tuberculosis(DR-TB),and to analyze the relationship between medication adherence and community-based DR-TB management,so as to provide reliable advises to improve the management model of DR-TB in China.Methods A self-designed questionnaire survey was conducted among 276 patients diagnosed during January and December in 2018 from 9 cities in Shandong and Zhejiang Province to collect basic information,medication adherence of patients and community-based management.Meanwhile,in-depth interviews were further conducted to understand the implementation and issues of the management.Results Out of 276 patients,166(60.15%)had decent medication adherence and most of them were under standardized community-based management.More patients with decent medication adherence had medication supervisors and received community-based follow-up compared to those with poor adherence,the differences were statistically significant(P<0.05).Unfortunately,the implementation of community-based management failed to completely follow the national guideline due to the poor cooperation of patients for the management and poor preventive ability of healthcare providers in community.Conclusions Community-based management can directly affect the medication adherence of patients with DR-TB.However,the management services were not strictly implemented in the study areas.Therefore,it is suggested that the government should enhance the special financial input and corresponding support to improve community management and service capacity.