Quality of tuberculosis care and its association with patient adherence to treatment in eight Ethiopian districts
Quality of tuberculosis care and its association with patient adherence to treatment in eight Ethiopian districts
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DOI：
10.1093/heapol/czp030
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发表时间：
2009-11-01
影响因子：
3.2
通讯作者：
Madeley, Richard J.
中科院分区：
文献类型：
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作者：
Mesfin, Mengiste M.;Newell, James N.;Madeley, Richard J.
背景 人们对埃塞俄比亚公共卫生机构结核病 (TB) 服务提供的质量及其与患者不坚持结核病治疗的关系知之甚少。本研究评估了结核病护理服务的组织、管理和流程及其对患者依从性结核病治疗的影响。方法从结核病护理服务的结构、流程和患者治疗结果三个角度对44个公共卫生机构的结核病护理质量进行调查。护理质量取决于是否遵守国家结核病指南。对结核病服务提供情况进行现场观察并对卫生服务提供者进行访谈，以评估结构性因素。医疗机构中的患者 (n = 237) 在完成治疗后接受了前瞻性访谈，以确定所提供的结核病护理的质量。通过对患者治疗登记册的审查和对患者家中未使用的结核病药物的审核，对治疗依从性的三项指标进行了量化[治疗中断（> = 2周）、未使用的结核病药物的可用性和治疗违约]。确定了质量差的服务提供结构和流程对这三项依从性衡量标准的影响。结果 44 家机构中有 18 家 (44%) 的结核病护理提供者未经培训，44 家中有 13 家 (25%) 没有提供日常门诊结核病护理。在 237 名患者中，43% 的患者中断治疗≥15 天，30% 的患者至少有 1 天未使用结核病药物。当护理人员没有受到地区结核病控制专家的充分监督并且无法处理患者的小病时，患者往往会中断治疗或不接受治疗。卫生机构无法提供每日结核病护理与缺少每日剂量有关。 结论 更好地培训结核病护理人员和地区监督支持可能是提高护理服务质量和患者治疗依从性的重要干预措施。
Background Little is known about the quality of tuberculosis (TB) service delivery in public health facilities in Ethiopia and its association with patients' non-adherence to TB treatment. This study assessed the organization, management and processes of TB care delivery, and their effects on patients' adherence to TB treatment.Methods The quality of TB care was investigated in 44 public health facilities from three perspectives: structure, processes of TB care delivery and patient treatment outcome. Quality of care was determined by adherence to national TB guidelines. On-site observations of TB service delivery and interviews with health providers were conducted to evaluate structural factors. Patients (n = 237) in the health facilities were interviewed prospectively at completion of their treatment to determine the quality of tuberculosis care delivered. Three measures of treatment adherence [treatment interruption (>= 2 weeks), availability of unused TB drugs and treatment default] were quantified from a review of patient treatment registers and an audit of unused TB drugs at patients' homes. Effects were identified of poor quality structures and processes of service delivery on these three measures of adherence.Results TB care providers were untrained in 18 (44%) of 44 facilities and daily outpatient TB care was not given in 13 of 44 (25%). Among the 237 patients, 43% interrupted treatment for >= 15 days and 30% had at least 1 day's dose of TB drugs unused. Patients tended to interrupt and default from treatment when their care provider had been inadequately supervised by district TB control experts and was incapable of dealing with patients' minor illnesses. Unavailability of daily TB care in health facilities was associated with missing daily doses.Conclusion Better training of TB care providers and district supervisory support could be important interventions to improve the quality of care delivery and patient adherence to treatment.