个案管理模式在耐多药肺结核患者服用贝达喹啉过程中的应用效果

Application effect of individual case management model during the process of taking bedaquiline in patients with MDR-PTB

选择2018年11月至2019年10月同济大学附属上海市肺科医院入组的50例服用贝达喹啉实施全程个案管理模式的耐多药肺结核(MDR-PTB)患者,对患者服药后2周、1个月、3个月及6个月的依从性[采用《Morisky服药依从性量表(中文修订版)》评价]及自我效能感[采用《一般自我效能感量表(中文版)》评价]进行评估。患者在干预前依从性得分为(5.25±0.15)分,干预后2周、1个月、3个月和6个月分别提高至(7.29±0.12)分、(7.68±0.07)分、(7.76±0.06)分和(7.96±0.03)分,差异有统计学意义(F=88.925,P<0.001);患者在干预前自我效能得分为(24.32±8.36)分,干预后2周、1个月、3个月和6个月分别提高至(25.20±7.94)分、(27.28±9.58)分、(36.48±5.81)分和(36.76±5.90)分,差异有统计学意义(F=15.532,P<0.001)。研究认为,对耐多药肺结核患者服用贝达喹啉实施个案管理模式可以提高患者服药依从性,提升患者自我效能。

A total of 50 patients with multidrug-resistant pulmonary tuberculosis(MDR-PTB),who received bedaquiline treatment in the Shanghai Pulmonary Hospital Affilicated to Tongji University from November 2018 to October 2019,were enrolled into this study.A individual case management model was used to all enrolled patients,and the medication adherence of those MDR-PTB patients was evaluated with the Morisky Medication Adherence Scale(MMAS,Chinese version)at 2 weeks,1 month,3 months and 6 months respectively after taking bedaquiline and their self-efficacy was evaluated with the General Self-efficacy Scale(GSE,Chinese version).The MMAS score of the patients was(5.25±0.15)before the intervention;after the intervention,it increased to(7.29±0.12),(7.68±0.07),(7.76±0.06)and(7.96±0.03)respectively at 2 weeks,1 month,3 months and 6 months of bedaquiline treatment,which was statistically significant higher than that before the intervention(F=88.925,P<0.001).The GSE score was(24.32±8.36)before the intervention;after the intervention,it was(25.20±7.94),(27.28±9.58),(36.48±5.81)and(36.76±5.90)respectively at 2 weeks,1 month,3 months and 6 months of bedaquiline treatment,which was statistically significant higher than that before the,intervention(F=15.532,P<0.001).The study suggested that the application of the individual case management model in the management of MDR-PTB patients taking bedaquiline can significantly improve their treatment compliance and self-efficacy.