中国偏远地区涂阳肺结核患者治疗依从性影响因素分析

Factors of treatment compliance among sputum smear-positive pulmonary tuberculosis patients in remote areas of China

目的:了解中国偏远地区涂阳肺结核患者治疗依从性相关影响因素。方法:按照随机抽样方法,从全国5个省随机抽取15个县,每个县随机抽取35名涂阳患者,共524例,进行问卷调查。结果:524例患者男性364例,占69.5%,女性占30.5%;漏服药人数为88例,占16.8%;治疗一段时间后,如果症状消失,未漏服药组中有5.7%的患者认为可以停止服药;漏服药组中则有19.3%的患者认为可以停止服药,两组服药认知差异具有统计学意义(P<0.05);漏服药组与未漏服药组在乡村医生和县医生访视频次方面差异具有统计学意义(P<0.05),漏服药组患者受访视次数少于未漏服药组患者;另外,漏服药组患者在复查次数以及具体查胸片次数方面少于未漏服药组(P<0.05)。结论:患者对抗结核治疗的认知程度、医务人员对患者的访视情况以及患者复查情况是影响偏远地区涂阳患者依从性的重要因素。因此,结防机构应采取相应措施,加强对结核病患者的健康教育,提高其对抗结核治疗的正确认识,同时医务人员应增加对患者的督导访视频次等,从而对提高患者的治疗依从性具有重要意义。

Objective To investigate the factors associated with low treatment compliance in sputum smear-positive tuberculosis（TB） patients in remote areas of China.Methods A questionnaire survey was conducted to a random sample of 524 smear positive TB patients in the 15 target counties.Results The average age of the patients was 47.7±17.5 years.69.5% of the patients were males,30.5% females.88 patients missed medication during the course of treatment（16.8%）.5.7% of the patients believed that the drugs could be withdrawn if symptoms disappeared after a period of treatment in the group without missed medication,however,19.3% of the patients believed that the drugs could be withdrawn in the group with missed medication,and the difference was significant（P0.05）.There was significant difference in visit times of village doctors and rural doctors between the group with missed medication and the one without（P0.05）.In addition,There was also significant difference in the referral and X-ray examination between the two groups（P0.05）.Conclusions The awareness levels of the patients on anti-TB treatment,the visit of doctors and the referral were the important factors of treatment compliance of TB patients in remote areas of China.Therefore,TB control agencies should take effective measures to increase visit times of doctors and strengthening health education about TB-related knowledge,and to improve compliance of patients.