以患者为中心的关怀服务对耐多药或利福平耐药肺结核患者治疗依从性的影响  

Impact of patient-centered care services on the treatment compliance among patients with multidrug-resistant or rifampicin-resistant pulmonary tuberculosis

作　　者：潘晶晶[1] 周惠 钱林美 竺丽梅[1] 刘巧[1] PAN Jingjing;ZHOU Hui;QIAN Linmei;ZHU Limei;LIU Qiao(Jiangsu Provincial Center for Disease Control and Prevention,Nanjing,Jiangsu 210009,China;The Sixth People's Hospital of Nantong City,Jiangsu Province,China)

机构地区：[1]江苏省疾病预防控制中心慢性传染病防制所,江苏南京210009 [2]江苏省南通市第六人民医院

出　　处：《中国血吸虫病防治杂志》2024年第5期494-501,共8页Chinese Journal of Schistosomiasis Control

基　　金：国家自然科学基金(82003516);江苏省卫生健康委员会科研重点项目面上项目(m2020020);江苏省卫生健康委员会科研重点项目(ZD2021052,ZDA2020022)。

摘　　要：目的观察以患者为中心的关怀服务对耐多药(multidrug-resistant,MDR)或利福平耐药(rifampicin resistant,RR)肺结核(pulmonary tuberculosis,PTB)(MDR/RR-PTB)患者治疗依从性的影响,为探索并推广适宜的MDR/RR-PTB患者院内护理流程提供科学依据。方法选择2017年1月—2020年10月南通市第六人民医院确诊的MDR/RR-PTB患者作为研究对象;其中,以2017年1月—2018年12月确诊的MDR/RR-PTB患者作为对照组,给予医院内常规管理;以2019年1月—2020年10月确诊的MDR/RR-PTB患者作为关怀组,予以患者为中心的个性化关怀服务,包括一对一咨询、定期小组活动、个案信息化管理、专人复诊提醒等。比较两组MDR/RR-PTB患者纳入治疗率、失访率、复诊率和痰检率的差异。结果共纳入104例MDR/RR-PTB患者,其中对照组54例、关怀组50例,两组患者性别、年龄分布差异均无统计学意义(χ^(2)=3.013、1.336,P均>0.05)。关怀组患者纳入治疗率为100%(50/50),高于对照组患者[87.04%(47/54)](P=0.013);关怀组患者随访期内失访率为0(0/43),低于对照组患者[19.05%(8/42)](P=0.002);关怀组患者总体复诊率为93.09%(377/405),高于对照组患者[83.56%(371/444)](χ^(2)=18.345,P<0.001);两组患者痰检率分别为83.70%(339/405)和79.28%(352/444),差异无统计学意义(χ^(2)=2.737,P>0.05)。结论开展以患者为中心的全方位关怀服务有助于提高MDR/RR-PTB患者纳入治疗率和治疗依从性,降低治疗期间失访率,值得推广应用。Objective To examine the effect of patient-centered care services on compliance to treatment among patients with multidrug-resistant(MDR)or rifampicin-resistant(RR)pulmonary tuberculosis(PTB),so as to provide the scientific evidence for promoting the widespread application of the appropriate nursing process of MDR/RR-PTB patients in the hospital.Methods The MDR/RR-PTB patients that were definitely diagnosed at the Sixth People's Hospital of Nantong City during the period from January 2017 to October 2020 were enrolled.The patients with confirmed diagnosis of MDR/RR-PTB during the period January 2017 to December 2018 served as controls,who were given routine care in the hospital,and those with confirmed diagnosis of MDR/RR-PTB during the period January 2019 to October 2020 served as the care group,who were given patient-centered personalized care services,including one-to-one consultations,periodic group activities,informatization case management,and personal reminder for return visits.The proportion of inclusion into treatment,loss to follow-up,return visits and sputum examinations were compared between the care and control groups.Results A total of 104 MDR/RR-PTB patients were included,including 54 cases in the control group and 50 cases in the care group.There was no significant difference in gender and age distribution between the two groups(χ^(2)=3.013,1.336,P>0.05).The proportion of inclusion into treatment was higher in the care group(100.00%,50/50)than in the control group(87.04%,47/54)(P=0.013),and the proportion of loss to follow-up was lower in the care group(0,0/43)than in the control group(19.05%,8/42)(P=0.002).In addition,the overall proportion of return visits was higher in the care group(93.09%,377/405)than in the control group(83.56%,371/444)(χ^(2)=18.345,P<0.001),and the proportion of sputum examinations was higher in the care group was(83.70%,339/405)than in the control group(79.28%,352/444)(χ^(2)=2.737,P=0.098).Conclusion Patient-centered care services facilitate the improvements in the prop

关 键 词：肺结核 耐多药肺结核 利福平耐药 关怀服务 治疗依从性 

分 类 号：R521[医药卫生—内科学]