对结核病患者实施移动通信直接面视下短程督导化疗的效果评价

The effectiveness evaluation of using mobile communication for directly observed short course chemotherapy on tuberculosis patients

目的对比常规直接面视下短程督导化疗(DOTS)和移动通信DOTS下的结核病患者督导管理,评价移动通信DOTS实施后的效果,为探索优化结核病治疗管理策略提供依据。方法采用随机数字表法将2018年1—6月在广东省结核病防治机构及定点医院被确诊为肺结核的174例患者进行随机分组;89例患者纳入常规DOTS组并根据《中国结核病防治规划实施工作指南(2008年版)》要求开展督导管理;85例患者纳入移动通信DOTS组,并采用了《结核病移动通信DOTS管理系统》进行全程、规范的结核病患者移动通信督导管理。通过现场收集两组患者诊疗转归及督导管理随访资料,对比分析应用不同DOTS方式下患者的规则服药、治疗转归、督导及随访管理情况。结果在治疗及转归方面,移动通信DOTS组患者强化期的规则服药率为97.6%(83/85),明显高于常规DOTS组的87.6%(78/89)(χ^2=6.297,P<0.05);常规DOTS组的药物不良反应处置时间的中位数(四分位数)[M(Q1,Q3)]为6(5,7)d,移动通信DOTS组为3(2,4)d,两组比较差异有统计学意义(Z=-5.643,P<0.01)。在督导随访方面,两组患者督导管理率均为100.0%,常规DOTS组接受规则督导率为88.8%(79/89),低于移动通信DOTS组的92.9%(79/85),但是差异无统计学意义(χ^2=0.909,P>0.05);移动通信DOTS组强化期和巩固期随访完成率均为100.0%(85/85),高于常规DOTS组的98.9%(88/89)和97.8%(87/89),差异无统计学意义(χ^2强化χ强化2=0.000,P>0.05;χ^2巩固χ巩固2=0.461,P>0.05)。结论结核病移动通信DOTS能够提供全面、连续和主动的结核病管理,移动通信DOTS能够有效提升患者的规则服药率、及时处置药物不良反应及强化定期随访管理工作。

Objective To compare conventional way of directly observed short course chemotherapy (DOTS) method and DOTS using mobile communication, to evaluate the effectiveness of TB treatment supervision under DOTS with mobile communication and to provide scientific evidence for tuberculosis control strategy development.Methods one hundred and seventy-four cases diagnosed with tuberculosis in TB control institutions and designated hospitals in Guangdong Province from January 2018 to June 2018, were randomly allocated to two groups according to the order of diagnosis using random number table. Eighty-nine cases were enrolled in conventional DOTS group and supervised following the guideline of China’s TB control program (Edition 2008);85 cases were enrolled in the mobile communication DOTS group which adopted TB mobile communication DOTS management system to conduct the whole-course and standardized supervision. Data of those two groups were collected, regularity of drug taking, treatment outcome, status of supervision and follow-up under different DOTS models were analyzed.Results In terms of treatment compliance and outcome, the regular medication rate in mobile communication group was 97.6%(83/85), which was significantly higher than the conventional DOTS group 87.6%(78/89)(χ^2=6.297,P<0.05). The median (quartile1 and quartile 3) gap time from adverse drug reactions onset to getting treated in conventional DOTS group was 6 (5,7) d, while in mobile communication DOTS group was 3 (2,4) d. The difference between those two groups was statistically significant (Z=-5.643, P<0.01). In terms of supervision and follow-up management, the supervision management rates of both groups were 100.0%. The regular supervision rate of conventional DOTS group was 88.8%(79/89), which was lower than the mobile communication DOTS group’s 92.9%(79/85), but it did not achieve statistical significance (χ^2=0.909,P>0.05). The completion rate of follow-up in the intensive and consolidated phases of the mobile DOTS group were both 100.0%, compared with 98.9%(88/89) and 97.8%(87/89) in the conventional DOTS group (intensive phase:χ^2=0.000, P>0.05;consolidated phase:χ^2=0.461, P>0.05).Conclusion TB mobile communication DOTS management system provides comprehensive, continuous and proactive management service, which can effectively improve the regular medication rate of patients, shorten the delay for adverse drug reactions treatment and strengthen management of regular follow-up.