贫困山区肺结核患者治疗依从性干预研究

发布时间：2018-02-01 07:40

本文关键词： 结核病贫困治疗依从性交通补助　出处：《第三军医大学》2012年硕士论文　论文类型：学位论文

【摘要】：背景：我国是世界上22个结核病高负担国家之一，结核病患者数量位居全球第二位。同时我国耐多药结核病疫情也非常严重，是27个耐药结核病高负担国家之一，耐多药患者数量位居全球第二位。发现和治愈肺结核患者是当前控制结核病疫情的最有效措施，而影响结核病治愈的关键因素之一是患者是否定期随访复查和规则服药。由于结核病是一种慢性传染病，其治疗疗程较长，肺结核患者往往不能坚持治疗，同时我市地理环境以山区为主，特别是在广大农村边远山区，由于交通不便、经济困难等原因，肺结核病患者治疗依从性较差，不能按时随访复查和取药。本研究调查分析贫困地区新涂阳肺结核患者治疗依从性的影响因素，同时开展治疗依从性干预研究，对该项工作进行系统的研究与评估。目的：1.分析贫困山区肺结核患者治疗依从性及其主要的影响因素，为提高贫困山区肺结核患者治疗依从性提供科学依据。2.在第一轮全球基金结核病项目的支持下，采用补助交通费对贫困山区肺结核患者治疗依从性进行干预研究，评价实行交通补助的效果，为国家制定相关政策提供依据。方法：1.选取重庆市国家级贫困县WX县作为实施区县，通过收集县结防机构登记的肺结核病患者的基本信息和定性研究(个人深入访谈和关键人物访谈)，分析贫困山区肺结核患者治疗依从性以及依从性的影响因素。2．在WX县连续收集了200例新涂阳肺结核患者进行干预研究(对患者实施适当的交通补助)，通过比较干预前后该地区的患者随访(痰检)、按时服药及治疗转归等的变化，以评价实施交通补助的干预效果。结果：1. WX县结防机构登记新涂阳肺结核患者379例，在随访期间，均按时规则复查者有302例，复查依从性为79.7%，不按时复查的现象在随访治疗的2月末、5月末、6月末均有发生，但主要发生治疗2月末，与治疗5、6月末复查依从性有统计学差异。患者年龄、患者居住地与结防机构距离、复查往返交通费用与患者复查依从性有统计学关联，，呈负相关。定性研究也发现患者家庭经济困难、患者对结防知识掌握不足、患者居住地离结防机构距离太远是影响患者复查依从性的主要因素。2.在发放交通补助费前后，患者治疗2月末随访查痰率和痰菌阴转率分别由71.9%提高到96.0%，59.0%提高到88.5%，治疗5月末随访查痰率由95.9%提高到98.5%，患者随访按时取药率由65.4%提高到99.5%，以上数据差异比较均有统计学意义，提示为肺结核患者提供交通补助有助于提高患者按时取药和查痰的比例。患者治疗5月末痰菌阴转率由95.9%提高到96.0%，治疗6月末随访查痰率由97.2%降低到96.0%，6月末痰菌阴转率由96.8%降低到96.0%，患者治愈率由96.8%降低到96.0%，治疗成功率由99.0降低到97.0%，以上数据差异比较均无统计学意义，提示为肺结核患者提供交通补助，在患者治疗后期对患者的复查依从性没有显著性影响。定性研究发现发放交通补助对患者复查依从性有一定帮助，但补助费用偏低。发放交通补助不但减轻了自身经济负担，同时也强化了患者主动复查的意识。结论：1.贫困山区肺结核患者复查依从性不高，主要发生在治疗2月末，提示结核病防治工作人员对患者治疗的头2个月强化期一定要密切关注，患者复查依从性的影响因素是患者年龄、居住地与结防机构距离、复查往返交通费用。2.为肺结核患者提供交通补助有助于提高患者按时取药和查痰的比例，同时有助于提高2月末痰菌阴转率，但在交通费用发放范围、发放额度和发放方式方面还需要进一步完善，要真正确保患者规则服药，达到治愈目的，还需要结合其他措施综合实施。
[Abstract]:Background: China is one of the world's 22 TB high burden countries, the number of TB patients ranked second in the world. At the same time the MDR-TB epidemic in China is very serious, is one of the 27 resistant TB high burden countries, the number of MDR-TB patients ranked second in the world. We are the most and cure of pulmonary tuberculosis patients the effective measures to control the epidemic, and one of the key factors affecting the cure of tuberculosis is whether the patient by regular follow-up and regular treatment. Due to tuberculosis is a chronic infectious disease, the treatment is long, pulmonary tuberculosis patients often fail to adhere to treatment, the geographical environment in mountainous areas, especially in the vast rural areas in remote mountainous areas, due to the inconvenience of traffic, economic difficulties and other reasons, patients with tuberculosis treatment compliance is poor, not timely follow up and get the medicine. This study investigated poverty area The influence factors of the treatment compliance of smear positive pulmonary tuberculosis patients, and the study of treatment compliance intervention are carried out, and the work is systematically studied and evaluated.
Objective: analysis of 1. patients with pulmonary tuberculosis in poor mountainous areas of the treatment compliance and its main influencing factors, to provide scientific basis for.2. in the first round of Global Fund TB project support to improve poor mountainous areas in patients with pulmonary tuberculosis treatment compliance, the transportation costs of subsidies in the impoverished mountainous area in patients with pulmonary tuberculosis treatment compliance of intervention, to evaluate the implementation of traffic subsidy the results provide the basis for the state to formulate relevant policies.
Methods: select 1. state-level poverty-stricken counties in WX County of Chongqing as the implementation of county county, through the collection of basic information and qualitative research node mechanism for preventing the registration of TB (in-depth interview and key informant interviews), analysis of the impact of poor mountainous areas in patients with pulmonary tuberculosis treatment compliance and compliance factors of.2. in WX County collected 200 cases of new smear positive pulmonary tuberculosis patients in intervention study (the implementation of the appropriate traffic subsidies for patients), the patients in the region by comparing before and after the intervention (sputum), change of medication and treatment outcome of the intervention to evaluate the transportation subsidies.
Results: 1. WX county TB institutions registration of new smear positive pulmonary tuberculosis patients in 379 cases during the follow-up period, according to rules of review 302 cases, review compliance was 79.7%, no time to review the phenomenon in 2 at the end of follow-up treatment at the end of 5, 6 at the end of the month have occurred, but the main treatment at the end of 2, there were significant differences in 5,6 at the end of treatment and examination compliance. Age, residence and proof mechanism for nodes of patients with distance was significantly associated with patient review and transportation expenses, examination compliance, negative correlation. The qualitative study also found that patients with family economic difficulties, lack of knowledge of TB patients, patients from home to TB institutions too close far is the main factor affecting the patients compliance of.2. before and after the payment of transportation subsidies, 2 at the end of follow-up sputum examination rate and sputum negative conversion rate increased from 71.9% to 96% patients, 59% to 88.5%, with 5 at the end of treatment Investigation of sputum rate increased from 95.9% to 98.5%, were taking medicine on time rate increased from 65.4% to 99.5%, the above data differences were statistically significant in patients with pulmonary tuberculosis and provide tips for transportation subsidies are helpful to improve patients to take medicine on time and the proportion of patients with sputum. 5 sputum negative conversion rate increased from 95.9% to 96%, 6 at the end of treatment follow-up sputum examination rate decreased from 97.2% to 6 at the end of 96%, the sputum negative conversion rate decreased from 96.8% to 96%, the cure rate of patients decreased from 96.8% to 96%, the success rate of treatment decreased from 99 to 97%, the above data differences were not statistically significant, suggesting that providing transportation subsidies for pulmonary tuberculosis patients in the treatment of patients with post review compliance of patients have no significant impact. Qualitative research found that distributed traffic subsidy is helpful to the patients compliance, but the subsidy costs low. Payment of transportation subsidies not only reduce their own The economic burden also strengthens the consciousness of the patient's reexamination.
Conclusion: 1. patients with pulmonary tuberculosis were in poor mountainous areas of compliance is not high, mainly occurred in 2 at the end of treatment, suggesting that TB control staff must pay close attention to the first 2 months of intensive treatment of patients with stage, factors affecting the patients compliance of patients age, place of residence and TB institutions from the review, round-trip transportation costs.2. provide transport subsidies for TB patients is helpful to improve the patients to take medicine and sputum proportion, while helping to improve the 2 sputum negative conversion rate, but in the transportation fee payment range, the payment amount and payment methods still need to be further improved, to truly ensure with the regular treatment, to achieve the purpose of cure, but also need to be combined with other measures of comprehensive implementation.

【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R521

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