Adherence to tuberculosis treatment: lessons from the urban setting of Delhi, India
Adherence to tuberculosis treatment: lessons from the urban setting of Delhi, India
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DOI：
10.1046/j.1365-3156.2003.01061.x
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发表时间：
2003-07-01
影响因子：
3.3
通讯作者：
Jain, RC
中科院分区：
文献类型：
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作者：
Jaiswal, A;Singh, V;Jain, RC
经修订的国家结核病控制方案纳入了世卫组织的DOTS战略*，于1990年代中期在印度推出。在采用新战略期间，在1996年至1998年间开展了一项业务研究项目，以评估德里两个胸科诊所Moti Nagar和Nehru Nagar的患者和提供者的需求和前景。本文报告了该项目的结果，集中于从40次对患者违约者的深入访谈以及从诊所和直接观察的治疗中心的非参与者观察中收集的信息。在Moti Nagar胸科诊所，尼赫鲁Nagar的1786名患者中有117名(6.5%)和1890名患者中的195名(10%)在治疗完成之前离开了治疗。有人争辩说，违约的原因是病人和方案的需要与优先事项之间的相关性不高，以及疾病及其治疗的特殊特点。卫生系统没有满足的病人需求包括方便的诊所时间安排，在家庭紧急情况下提供治疗的安排，以及为酗酒者等复杂病例提供服务。服务提供者面临的问题是与卫生工作人员的人际沟通不畅，诊所缺乏关注和支持，如果患者错过治疗，他们很难重新进入系统，在某些地区，距离诊所很远。与疾病相关的问题是工作人员无法处理药物副作用，以及患者将幸福等同于治愈的观念。简单、实用的措施可以改善结核病治疗的提供：更灵活的工作时间，为贫困患者提供去诊所的津贴，以及培训卫生保健人员进行尊重的沟通和监测药物副作用。调查结果表明，人们需要重新考虑通常给患者贴上的“违约者”标签。还强调了未来运筹学研究的重要领域。
The Revised National Tuberculosis Control Programme (RNTCP), which incorporated the WHO DOTS strategy* was introduced in India in the mid-1990s. An operational research project was conducted between 1996 and 1998 to assess the needs and perspectives of patients and providers in two chest clinics in Delhi, Moti Nagar and Nehru Nagar, during the introduction of the new strategy. This paper reports on the findings of the project, concentrating on information collected from 40 in-depth interviews with patient defaulters and from non-participant observations in clinics and directly observed treatment centres. In Moti Nagar chest clinic, 117 of 1786 (6.5%) patients and 195 of 1890 (10%) patients in Nehru Nagar left care before their treatment was complete. It was argued that the reasons for default stem from a poor correlation between patient and programme needs and priorities, and from particular characteristics of the disease and its treatment. Patient needs that were not met by the health system included convenient clinic timings, arrangements for the provision for treatment in the event of a family emergency and provision for complicated cases like alcoholics. The problems facing the provider were poor interpersonal communication with the health staff, lack of attention and support at the clinic, difficulty for patients to re-enter the system if they missed treatment and, in certain areas, long distances to the clinic. Problems related to diseases were inability of the staff to deal with drug side-effects, and patients' conception of equating well-being with cure. Simple, practical measures could improve the provision of tuberculosis (TB) treatment: more flexible hours, allowances for poor patients to reach the clinics and training health care staff for respectful communication and monitoring drug side-effects. The findings indicate a need to rethink the label of 'defaulter' often given to the patients. The important areas for future operational research is also highlighted.