以患者为中心的结核病咨询服务干预效果分析

Analysis on intervention effectiveness of tuberculosis counseling services using patient-centered approach

目的分析以患者为中心的结核病咨询服务干预前后的效果。方法采用整群随机抽样法对2016年4—10月新疆维吾尔自治区胸科医院124例住院结核病患者实施以患者为中心的结核病咨询服务，并对咨询服务干预前后结核病防治知识的知晓情况及咨询服务后患者的满意度进行比较。使用SPSS17．0软件包对数据进行描述性分析，率的比较采用x2检验，以P〈0．05为差异有统计学意义。结果对124例结核病患者实施咨询服务干预后，结核病相关知识总回答正确率由干预前的54．23％（1614／2976）提高到干预后的77．79％（2315／2976）（x2=12．37，P=0．000）；干预前单一知识“结核病可以治好”的知晓率最高[78．23％（97／124）]，而“普通肺结核患者治疗期间需要送痰检查的时间”的知晓率最低[12．90％（16／124）]；干预后单一知识“结核病是通过空气传播”的知晓率最高[99．19％（123／124）]，“普通肺结核患者治疗期间需要送痰检查的时间”的知晓率最低E45．16％（56／124）]。咨询服务干预后结核病患者对结核病防治知识的知晓率在结核病治疗知识[80．65％（700／868）]、结核病传播方式[78．76％（293／372）]、防止结核病传染采取的措施[82．80％（616／744）]、结核病常见症状[77．02％（382／496）]、耐药结核病产生的原因[65．32％（324／496）]方面均高于咨询服务干预前的知晓率[分别为57．60％（500／868）、56．45%（210／372）、59．95%（446／744）、55．85%（277／496）、36．49％（181／496）]（x2=12．45，P=0．000；x2=11．36，P=0．000；x2=12．78，P=0．000；x2=10．05。P=0．002；x2=16．63，P=0．000）。患者对“科室咨询员咨询服务”总体满意度为93．55％（116／124），对“咨询服务态度”的满意度最低（87．10％，108／124）。结论结核病患者咨询服务干预有助于患者了解结核病防治方面的相关知识，改变不良行为，提高治疗依从性。

Objective To analyze the effectiveness before and after the tuberculosis （TB） counseling services using a patient-centered approaeh were provided to the patients. Methods The cluster random sampling method was used and 124 patients with TB, who stayed at the Xinjiang Uygur Autonomous Region Chest Hospital for TB treatment from April to October 2016, were randomly sampled and involved in this study. The TB consultation services were provided to the enrolled patients and a patienrcentered approach was used during this intervention. The related information was collected before and after the intervention was carried out, and the situation of TB knowledge awareness and the degree of patients＇ satisfaction to the counseling services were analyzed and compared. SPSS 17. 0 version software package was used for the descriptive analysis of the data. The Chi-square test was used to compare the rates and P〈0.05 was regarded to have statistically significant difference. Results The overall rate of the patients who gave correct answers to the TB related knowledge in 124 cases was significantly improved from 54.23% （1614/2976） before the intervention to 77.79% （2315/2976） after the intervention （x2= 12.37, P=0. 000）. Before the intervention, the highest awareness rate （78. 23% （97/124）） to the single TB related knowledge in 124 patients was regarding to the knowledge of ＂TB can be cured＂ while this rate was the lowest （12. 90% （16/124）） regarding to the knowledge of ＂Sputum examination time during the treatment of susceptible pulmonary TB patients＂; after the intervention, the highest awareness rate （99. 19% （123/124）） to the single TB related knowledge in 124 patients was regarding to the knowledge of ＂TB can be transmitted through the air＂ while this rate was the lowest （45.16 % （56/124）） regarding to the knowledge of ＂Sputum examination time during the treatment of susceptible pulmonary TB patients＂. The awareness rate of the patients regarding to the following TB related knowledge were significantly increased after the intervention compared to those before the intervention, including the knowledge related to TB treatment （80.65% （700/868） vs 57.60% （500/868） ; x2 = 12.45, P = 0. 000）, the knowledge related to the modes of TB transmission （78. 76% （293/372） vs 56.45% （210/372）; x2 = 11.36, P= 0. 000）, the knowledge related to the measures for preventing TB transmission （82.80% （616/744） vs 59.95% （446/744） ; x2 =12.78, P=0. 000）, the knowledge related to the common symptoms of TB （77.02% （382/496） vs 55.85% （277/496）; x2= 10.05, P= 0. 002）, and the knowledge related to the reasons of drug resistant TB development （65.32% （324/496） vs 36.49% （181/496）; X2 =16.63, P=0. 000）. The overall satisfaction rate of the patients to the counseling services was 93.55% （116/124） ; the patients＇ satisfaction rate to the ＂Attitude of the consulting services providers＂ was the lowest （87.10%, 108/124）. Conclusion The counseling services providing to the patients with TB can help the patients to better understand the knowledge related to TB prevention and treatment, change their behaviors and improve their treatment adherence.