安徽省流动人口结核病防治干预措施的效果评价

Effect evaluation of tuberculosis prevention and control intervention among floating population in Anhuiprovince

目的了解安徽省流动人口肺结核患者治疗管理现状，评价全球基金项目干预措施对提高流动人口结核病患者的治疗依从性的效果。方法调查点选择实施全球基金结核病流动人口项目的全部5个地区（项目组）和按照单纯随机抽样方法在全省抽取5个非项目地区（非项目组），纳入2010年10月至2011年10月期间完成疗程的流动人口肺结核患者，按照患者就诊的时间顺序，共计纳入230例患者。对全部患者进行问卷调查，收回有效问卷229例，问卷有效率为99．57％；其中项目组111例，非项目组118例。调查数据采用EpiData3．1双人双重录入计算机，用SPSS13．0统计软件进行分析。主要评价指标为漏服药率、不良反应发生率、是否医务人员访视与医务人员访视类型、服药意识等。样本率比较采用7。检验，以a-0．05为检验水准。结果项目组111例患者中有19例患者发生漏服药，占17．12％，而非项目组118例患者中有42例患者发生漏服药，占35．59％，差异有统计学意义（X2=9．99，P〈0．05）；项目组（因1例缺项，总例数为110例）有35例患者发生不良反应，占31．82％（35／110），非项目组有56例患者发生不良反应，占47．46％（56／118），差异有统计学意义（X2=5．81，P〈0．05）；项目组有93例患者（83．78％）接受过医务人员访视，显著高于非项目组（缺项1例）的84例患者（71．79％），差异有统计学意义（7。一4．72，P〈0．05）；且两组患者接受访视的医务人员（县医、乡级医生、村级医生）类型中，项目组接受县（乡）医访视占75．27％（70／93），非项目组接受县（乡）医访视只占59．52％（50／84），差异有统计学意义（X2=5．01，P〈0．05）；经过治疗，疗程未结束，症状消失，项目组有4例患者（3．60％）认为可以停止服药，而非项目组（缺项7例）有12例患者（10．81％）认为可以停止服药，差异有统计学意义（X2=4．31，P〈0．05）。结论通过全球基金流动人口项目有效的干预措施，项目地区流动人口肺结核患者的治疗依从性及正确服药意识显著优于非项目地区，不良反应发生率也低于非项目地区。

Objective To investigate the status of tuberculosis （TB） patient treatment and management among floating population in Anhui province, and to evaluate the effect of Global Fund （GF） interventions in patient＇s treatment compliance improvement. Methods Data collection used structured questionnaire administered to mobile patients enrolled and completed TB treatment between October 2010 to October 2011 in all 5 GF areas （GF group） and 5 randomly selected nowGF areas （non-GF group） in Anhui provinc〈 A total of 229 patients （99.57%, 229/230） completed the survey. They consisted of 111 cases from GF group and 118 from non-GF group. Survey data entry and analysis utilized EpiData 3.1 and SPSS 13.0 statistical software. Main evaluation indicators included rate of missing doses, incidence of adverse reactions, times and type of doctor visits, and patients＇ awareness about TB medication. Differences in these indicators among patients from GF versus non-GF groups were tested using Chi- square test and a=0.05 as cut point for refuse or accept null hypothesis. Results The proportion of patient who had missed prescribed medications accounted for 17. 12% （19） and 35.59% （42） in GF （111 in total） group and non-GF（118） group respectively and the difference was statistically significant （Ze ： 9. 99, P〈 0. 05）. Significant difference was also observed in the incidence of adverse reactions between the two groups, 31.82% （35/110） for GF group compared with 47.46% （56/118） for nonGF group （X2=5.81, P〈0.05）. Follow-up visits happened to 93 patients （83. 78%） in the GF group which was significantly higher than that in the nowGF group （71.79%X2=4.72, P〈0.05）. And the composition of doctors who had performed the follow-up visit was also differem For GF group, doctors from county or township level accounted for 75.27% （70/93）, while the same indicator for nonGF group was only 59. 52% （50/84） （X2= 5.01,P〈0.05）. The proportion of GF patients who believed that medica- tion can be stopped i symptoms disappeared after a period of treatment was also signi{lcantIy lower than that of non- GF patients （3.60% versus 10.81% X2 = 4.31, P〈0.05）. Conclusion After GF supported interventions, patients＇ treatment compliance and correct medication awareness of rib treatment among mobile population in GF areas were significantly hetter than those of patients in non-GF areas and the incidence of adverse reactions was also lower in GF areas than in non-GF areas.