格林模式干预对耐多药结核病患者治疗依从性的影响

The influence of PRECEDE-PROCEED model on the therapeutic compliance of MDR-TB patients

目的 探讨格林模式干预对耐多药肺结核病患者治疗依从性的影响.方法 对我院住院并确诊,纳入“中国全球基金结核病项目”治疗的耐多药结核病（MDR-TB）患者,选取2011年7月至2012年12月住院的MDR-TB患者90例为干预组;选取2010年1月至2011年6月我院住院的MDR-TB患者92例为对照组,剔除失访、死亡患者,对照组79例,干预组82例完成研究.两组均采用个体化治疗方案,治疗24个月（强化期6个月,巩固期18个月）,对照组采用常规健康教育,干预组同时增加格林模式指导,形成患者治疗依从性的倾向、促成和强化因素.治疗过程中（前6个月每个月1次,后18个月每2个月1次）对患者进行痰涂片、痰菌培养、肝功能、血尿常规等项目的检查.分类资料用“率”描述,采用Excel表建立数据库,SPSS 13.0软件进行统计学分析,组间比较采用卡方检验,观察两组患者结核病防治知识知晓率、治疗的依从性及治愈率.结果 干预组患者结核病防治知识总知晓率为89.0％,明显高于对照组（58.2％）,差异有统计学意义（x^2=19.8,P＜0.01）;干预组患者治疗依从性率为91.5％,明显高于对照组（67.1％）,差异有统计学意义（x^2=14.67,P＜0.01）;干预组患者痰菌转阴率为65.9％,高于对照组（43.0％）,差异有统计学意义（x^2=7.91,P＜0.05）.结论 对耐多药肺结核病患者采取格林模式干预可有效提高治疗依从性.

Objective To explore the influence of PRECEDE-PROCEED model on the therapeutic compliance of MDR-TB patients. Methods From the patient who were hospitalized and diagnosed as MDR-TB and admitted by China Global Fund TB Program, 90 patients who were hospitalized from July 2011 to December 2012 （intervention group） and 92 patients who were hospitalized from January 2010 to June 2011 （control group） were enrolled. There were 79 cases in contrast group and 82 cases in intervention group after elimination of the loss of follow-up and death cases. The patients in two groups were both treated with individualized regimen for 24 months （including 6 months intensive phase and 18 months consolidation phase）. Conventional health education was applied in the patients in two groups. In addition, we provided the guidance of PRECEDE-PROCEED model to intervention group to form predisposing, enabling and reinforcing factors. During the course of treatment, the following tests were taken once a month within the first 6 months and once two months within the final 18 months： sputum smear, sputum culture, liver function, routine test of blood and urine and so on. Rate was used to describe categorical data, the database was established by Excel, and SPSS 13.0 software was applied for data analysis. Chi-square test was used to corn pare the awareness rate, compliance of treatment and care rate between two groups. Results The awareness rate of the patient in intervention group was 89.0%, which was significantly higher than control group （58. 2%）. The difference was statistically significant （x^2 = 19.8, P〈 0. 01）. The treatment adherence rate in intervention was 91.5%, and was significantly higher than control group （67.1%） （x^2 =14. 67, P〈0.01）. The sputum conversion rate of the intervention group was 65.9%, which was significantly higher than control group （43.0%）（x^2 = 7.91, P〈 0. 05）. Conclusion PRECEDE-PROCEED model intervention can effectively improve the treatment compliance of MDR-TB patients.