全程管理模式对幽门螺杆菌感染患者根除治疗服药依从性和复查率的影响

Effect of Whole-course Management on Medication Adherence and Reexamination Rate of Helicobacter pylori Eradication Therapy

背景:幽门螺杆菌(Hp)与消化性溃疡、胃癌等胃肠道疾病密切相关,根除Hp是预防和治疗Hp相关疾病的重要手段,而患者管理是提高根除率的关键环节之一。目的:探索全程管理模式对Hp感染患者根除治疗服药依从性和复查率的影响。方法:连续收集于2020年6月-2020年11月在苏州大学附属第一医院Hp专病门诊接受根除治疗的患者。2020年6月-2020年8月接受根除治疗者仅在就诊时被告知服药方法和复查时间,作为对照组(n=112);2020年9月-2020年11月接受根除治疗者实施“告知服药方法和复查时间+微信平台线上随诊+微信和电话提醒复查”的全程管理模式,作为观察组(n=112)。两组均使用14 d铋剂四联方案根除Hp,并被告知在服药结束后4~8周完成^(13)C-尿素呼气试验复查,服药结束后第9周通过电话确认服药和复查情况。结果:对照组治疗完成率为91.1%(102/112),观察组为98.2%(110/112),观察组服药依从性显著优于对照组(P=0.018),复查率亦显著高于对照组(69.6%对50.9%,P=0.004);观察组不良反应停药率低于对照组,但差异无统计学意义(8.3%对16.7%,P=0.636)。结论:全程管理模式可有效提高Hp感染患者根除治疗的服药依从性和复查率。

Background:Helicobacter pylori(Hp)is closely associated with peptic ulcer,gastric cancer and other gastrointestinal diseases.Eradication therapy is the main approach to prevent and treat Hp-associated diseases,and patient management is crucial for improving the efficacy of eradication therapy.Aims:To explore the effect of whole-course management on medication adherence and reexamination rate of Hp eradication therapy.Methods:Patients who received Hp eradication therapy in the Hp Specialist Clinic of the First Affiliated Hospital of Soochow University from June 2020 to November 2020 were recruited consecutively.One hundred and twelve patients who received eradication therapy between June 2020 and August 2020 were served as the control group,and 112 patients who received eradication therapy between September 2020 and November 2020 were served as the observation group.Patients in control group were informed only the medication method and reexamination time,while patients in observation group were given the whole-course management composed of informing medication method and reexamination time plus following up online by WeChat and reminding the reexamination by WeChat and by phone.Patients in both groups received a 14-day bismuth quadruple therapy,and were told to undergo ^(13)C-urea breath test 4-8 weeks after completion of therapy.Medication and reexamination were confirmed by phone 9 weeks after completion of therapy.Results:The treatment completion rate was 91.1%(102/112)in control group and 98.2%(110/112)in observation group.The medication adherence of the observation group was superior to that of the control group(P=0.018),so did the reexamination rate(69.6%vs.50.9%,P=0.004).Rate of drug withdrawal due to adverse effects was lower in observation group than in control group,however,the difference was not significant(8.3%vs.16.7%,P=0.636).Conclusions:Whole-course management can improve the medication adherence and reexamination rate of Hp eradication therapy effectively.