贵州省肺结核患者治疗依从性评分系统应用研究

发布时间：2018-12-06 21:09

【摘要】：背景结核病是当前全球最重要的传染性疾病之一,中国目前是世界上22个结核病高负担国家之一,居第二位,贵州省肺结核疫情远高于全国平均水平。发现和治愈患者是我国现阶段防控结核的主要措施,而患者的治疗依从性是治愈肺结核的关键。目的分析贵州省肺结核病患者治疗依从性现状及影响因素,评价肺结核患者依从性量表(ARS量表)对依从性评价的效果,研发提高肺结核患者治疗依从性的干预措施。研究结果有助于优化贵州省有限的结核病防治资源,达到节约社会疾病控制成本与进一步提高我省总体治疗依从率的双重目的,具有重要的公共卫生学意义。方法在贵州省88个县中随机抽取10个县,选取这10个县6个月期间的活动性肺结核患者作为研究对象,运用现况调查分析贵州省肺结核病患者治疗依从性现状;运用队列研究评价ARS量表对依从性评价的效果;运用随机对照试验研究评价依从性干预措施的效果。研究结果1、本次调查的1749例肺结核患者,在复查、取药过程中至少出现过1次不依从的1001例,占57.2%。出现过2次不依从占17.2%;出现过3次不依从占5.1%。在1001例出现不依从患者中,延迟2~9天的占50%左右;延迟天数大于30天的,在疗程结束时更是高达19.8%;患者诊断结果、患者初复治情况与总体依从情况有显著性差异(P0.05)。患者诊断结果、初复治情况同时为患者治疗总体依从性的影响因素(P0.05)。2、ARS量表评分结果与实际依从性结果有一定的吻合度(Kappa系数=0.403,P0.001),灵敏度为71.1%,特异度为70.2%,正确指数为0.41。在众多影响因素中ARS评分和初复治情况均是患者实际依从性的主要影响因素,P0.05。经多因素分析,ARS评分OR=5.649,表明在初复治情况相同的前提下,ARS评分为依从者的复查依从性是评分为不依从者的5.649倍。3、干预组5月末和6(8)月末治疗依从性显著高于对照组;在出现延迟的患者中,干预组5月末和6(8)月末平均延迟天数显著低于对照组;经多因素分析,提示“是否干预”是患者治疗依从性的重要影响因素。研究结论1、贵州省肺结核患者规范治疗比例非常低;贵州省肺结核患者延迟程度还比较轻;总体依从性涂阳患者较涂阴患者好,初治患者较复治患者好。2、ARS量表能较准确地前瞻性评估患者治疗依从性,但是需要进一步改进。3、开发的开展适当健康教育和县级强化督导的干预措施有效,能提高患者治疗依从性。
[Abstract]:Background Tuberculosis is one of the most important infectious diseases in the world. At present, China is one of the 22 countries with high TB burden in the world, ranking the second place. The epidemic situation of tuberculosis in Guizhou Province is much higher than the national average. Finding and curing patients is the main measure to prevent and control tuberculosis in our country at present, and the treatment compliance of patients is the key to cure tuberculosis. Objective to analyze the status quo and influencing factors of pulmonary tuberculosis compliance in Guizhou province, to evaluate the effect of pulmonary tuberculosis compliance scale (ARS), and to develop intervention measures to improve pulmonary tuberculosis compliance. The results are helpful to optimize the limited resources of tuberculosis prevention and control in Guizhou province, to save the cost of social disease control and to further improve the compliance rate of general treatment in Guizhou Province, which has important public health significance. Methods A total of 10 counties were randomly selected from 88 counties of Guizhou Province. The patients with active pulmonary tuberculosis in these 10 counties were selected as research objects. The current status of compliance of pulmonary tuberculosis patients in Guizhou Province was analyzed. Cohort study was used to evaluate the effectiveness of ARS scale for compliance evaluation, and randomized controlled trial was used to evaluate the effectiveness of compliance intervention. Results 1. 1001 cases (57.2%) of the 1749 pulmonary tuberculosis patients in this study who had failed to comply at least once in the course of reexamination and withdrawal. There have been two disobedience accounts for 17.2 and three disobedience for 5.1. Of the 1001 patients who did not comply, 50% had a delay of 2 or 9 days, and those with a delay of more than 30 days were as high as 19. 8% at the end of the course of treatment. There was significant difference between the initial relapse and the overall compliance of the patients (P0.05). The initial relapse was also the influencing factor of the patients' overall compliance (P0.05). 2There was a certain degree of agreement between the scores of ARS and the actual compliance (Kappa coefficient = 0.403 P0.001). The sensitivity was 71.1, the specificity was 70.2, and the correct index was 0.41. Among the many influencing factors, ARS score and initial relapse were the main influencing factors of patients' actual compliance (P0.05). By multivariate analysis, ARS score OR=5.649, showed that the reexamination compliance of those with ARS score was 5.649 times higher than that of those who did not. The therapeutic compliance of the intervention group was significantly higher than that of the control group at the end of May and the end of 6 (8). The average delay days in the intervention group at the end of May and at the end of 6 (August) were significantly lower than those in the control group. Conclusion 1, the proportion of standardized treatment for pulmonary tuberculosis patients in Guizhou Province is very low, the delay degree of pulmonary tuberculosis patients in Guizhou Province is still relatively light; The overall compliance of smear positive patients is better than that of smear negative patients, and that of newly treated patients is better than that of re-treated patients. 2 the ARS scale can accurately and prospectively evaluate the patients' compliance with treatment, but further improvement is needed. The developed intervention measures of appropriate health education and intensive supervision at county level are effective and can improve the compliance of patients with treatment.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R521

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