边远山区新发肺结核患者采用家庭成员督导化疗依从性的观察

Observation of The Compliance of DOTS by Family Members for Emerging Tuberculosis Patients in Outlying Mountain Area

目的探讨家庭成员短程督导化疗对提高新发肺结核患者治疗依从性的效果。方法采用2006年1—12月密云县户籍新发患者为结核病防治所和社区卫生服务中心医务人员督导的(Ⅰ组)为对照组,2007年1—12月密云县户籍新发肺结核患者为家庭成员督导的为试验组(Ⅱ组),分别在结核病防治所、社区卫生服务中心和家庭督导员督导下实施短程督导化疗,比较2组治疗依从性和治疗效果。结果2006年共登记新发肺结核128例,2007年共登记新发肺结核133例。即:对照组(Ⅰ组)128例,试验组(Ⅱ组)133例;Ⅰ组2、5、6月末随访查痰率分别为95.3%、90.6%和85.9%,Ⅱ组2、5、6月末随访查痰率分别为97.7%、94.0%和94.7%。II组6月末随访查痰率明显高于Ⅰ组(P<0.01)。Ⅰ组和Ⅱ组规则服药率分别为93.8%和97.7%,Ⅱ组规则服药率明显高于Ⅰ组(P<0.01)。Ⅰ组和Ⅱ组的治愈率分别为88.3%和94.7%,Ⅱ组治愈率高于Ⅰ组。结论在推广全程督导化疗有困难的边远山区和贫困农村,鼓励具有一定文化程度,经过培训的结核病患者家庭成员或志愿者担任家庭督导员,督导病人按时服药及复查,可以弥补辖区结核病防治所、社区卫生服务中心医生在部分农村地区做全程督导治疗有困难,从而提高患者治疗依从性和全程督导短程化疗(DOTS)实施质量。

[Objective]To investigate the effect of DOTS compliance by family members for emerging tuberculosis （TB） patients.[Methods]The local new cases diagnosed in Miyun County in 2006 who received DOTS by TB dispensary and community health centers was taken as the control group（Group I）,and the same kind of cases in 2007 received DOTS by family members as the experimental group（Group II ）.The treatment compliance and effect of the 2 groups were compared.[Results]Totally 128 cases of new diagnosed TB （control group） were registered in 2006,and 133 cases （experimental group） in 2007.At the end of the 2nd,the 5th and the 6th month,sputum examination rate of Group I was 95.3%,90.6% and 85.9%,respectively,and that of Group II was 97.7%,94.0% and 94.7%,respectively.The 6th month sputum examination rate of Group II was significantly higher than that of Group I （P〈0.01）.The rate of medicine regularly taking of Group I and Group II was 93.8% and 97.7%,respectively;that of Group II was significantly higher than Group I（P〈0.01）.The cure rate of Group I and Group II was 88.3% and 94.7%,respectively,that of Group II was significantly higher than Group I（P〈0.01）.[Conclusion]It is encouraged that the family members of the TB patients and the volunteers who have been trained to supervise the patients to take medicine and recheck in outlying mountain area and the poor rural areas where DOTS are difficult to perform for the TB cases.It can solve the problem of implementation of DOTS in rural areas by doctors of TB dispensary and community health centers,and improve the treatment compliance of the cases and the quality of the DOTS.