语音短信督导系统在城区涂阳肺结核患者治疗管理中的应用

The application effect of Voice Reminding Messages System in the therapeutic management among smear positive tuberculosis patients in urban areas

目的 评价语音短信督导系统（VRMS）在涂阳肺结核患者治疗管理中的应用效果和局限性.方法 选取黑龙江省哈尔滨市南岗区结核病防治所2007年7月10日至2008年7月14日登记治疗的238例涂阳肺结核患者,收集VRMS对患者发送的语音短信提醒信息的发送和回复情况,分析发送失败或发送成功但未回复服药信息产生的原因.结果 VRMS短信平台向238例涂阳患者发送的21 478条语音提醒信息中,38.4％（8242/21 478）发送失败,61.6％ （13 236/21 478）发送成功.语音短信发送成功率,女性是男性的0.915 （95％CI：0.863～0.969）倍（χ^2=9.05,P=0.003）;40～59岁组和60岁以上组分别是19岁以下组的1.512 （95％CI：1.300～1.759）倍和1.228 （95％CI：1.024～1.474）倍,年龄组间差异有统计学意义（χ^2=111.59,P＜0.01）;使用固定电话和小灵通分别是使用手机的1.369 （95％CI：1.264～1.484）倍和1.479 （95％CI：1.350～1.621）倍,电话种类间差异有统计学意义（χ^2=114.60,P＜0.01）.提醒信息发送成功率在238例患者中的分布情况：低于60％的患者有100例（42.0％,100/238）;60％～：28例（11.8％）;70％～：33例（13.9％）;80％～：40例（16.8％）;90％～：30例（12.6％）;95％～99％：7例（2.9％）.发送成功的信息中,9202条（69.5％,9202/13 236）获得患者服药情况回复,4034条（30.5％,4034/13 236）未被回复.服药信息回复率在238例患者中的分布情况：低于60％的患者为95例（39.9％,95/238）;60％～：19例（8.0％）;70％～：18例（7.6％）;80％～：44（18.5％）;90％～：22例（9.2％）;100％：40例（16.8％）.12 276条发送失败或未回复服药情况的信息中有3062条（24.9％,3062/12 276）被督导医生电话随访并记录其原因,分别为“语音短信系统问题”（83.0％,2541/3062）、手机原因（11.0％,337/3062）、患者问题（6.0％,184/3062）.结论 VRMS对提醒涂阳肺结核患者按时服药及让医生了解患者服药状况方面有一定的积极意义,但是目前的发送成功率和回复率均较低,需要进一步研究改善.

Objective To analyze the application effects and limitations of the Voice Reminding Messages System （VRMS） in the therapeutic management among smear positive tuberculosis （TB） patients in Nangang District,Harbin City of Heilongjiang Province in China.Methods We collected and analyzed the message of voice reminding message （VRM） to detect the sending and responding status,and analyzed non-responding pieces for the causes of delivery failure or non-responding via the message platform during the treatment of 238 smear positive TB patients,who lived in Nangang District and were treated and managed from July,2007 to July,2008.Results Among 21 478 pieces of VRM sent to 238 smear positive TB patients via the message platform,13 236 （61.6%） pieces were successfully delivered,and 8242 （38.4%） pieces failed.The rates of successful sending VRM were significances different in the different groups of gender,age and kinds of phones：the rate in female was 0.915 （95%CI：0.863-0.969） times as high as that in male;the rate in 40-59 and 60-groups were 1.512 （95%CI：1.300-1.759） times and 1.228 （95%CI：1.024-1.474） times higher than that in ≤19 group;the rate in patients with fixed-line phone and smart were 1.369 （95%CI：1.264-1.484） and 1.479 （95%CI：1.350-1.621） times higher than that with mobile phone （χ^2 =9.05,P=0.003;χ^2 =111.59,P〈0.01;χ^2 =114.60,P〈0.01）.The successful sending rate of VRM in 100 patients （42.0%,100/238） was less than 60%,in 28 （11.8%） was 60%-69%,in 33 （13.9%） was 70%-79%,in 40 （16.8%） was 80%-89%,in 30 （12.6%） was 90%-94%,in 7 （2.9%） was 95%-99%.Among 13 236 pieces of,doctors received 9202 （69.5%） pieces responding and 4034 （30.5%） pieces of VRM weren＆#39;t responded by the patients.The responding rate in 95 patients （39.9%,95/238） was less than 60%,in 19 （8.0%） was 60%-69%,in 18 （7.6%） was 70%-79%,44 （18.5%） was 80%-89%,in 22 （9.2%） was 90%-99%,in 40 （16.8%） was 100%.Of 12 276 （57.2% of total 21 478 pieces of VRM） unsuccessful sending or non-responding pieces,3062 pieces （24.9%,3062/12 276） were called back and requested the reasons for their non-responded by the doctors.The main reason for unsuccessful sending or non-responding was the ＆quot;Problem of VRMS＆quot; （83.0%,2541/3062）,＆quot;Problem of telephones＆quot; （11.0%,337/3062）,＆quot;Problem of patients＆quot; （6.0%,184/306）.Conclusion The VRMS can only play a partial role in reminding the TB patients of taking their medicine on time and keeping the doctors aware of the patients＆#39; status in medicine taking.However,at present,the successful sending rate and responding rate of VRMS were lower and need be improved.