House calls by community health workers and public health nurses to improve adherence to isoniazid monotherapy for latent tuberculosis infection: a retrospective study
House calls by community health workers and public health nurses to improve adherence to isoniazid monotherapy for latent tuberculosis infection: a retrospective study
复制标题
DOI：
10.1186/1471-2458-13-894
复制
发表时间：
2013-09-28
影响因子：
4.5
通讯作者：
Bhatia, Gulshan
中科院分区：
文献类型：
--
作者：
Chang, Alicia H.;Polesky, Andrea;Bhatia, Gulshan
背景：尽管异烟肼（INH）单药治疗结核潜伏感染（LTBI）的疗效已得到证实，但患者依从性并不理想。已经研究了各种策略来提高依从性，但所有这些策略都是基于诊所或治疗计划。在圣克拉拉谷结核病诊所，我们的做法是将一部分高危LTBI患者转诊到公共卫生部门，每月在家中而不是在诊所进行随访。我们的目标是评估是否由社区卫生工作者和公共卫生护士的出诊影响INH的依从性或频率的不良反应。方法：我们回顾性研究了3918 LTBI患者谁收到INH。根据主治医生的判断，986例（25.2%）接受了上门服务，而不是门诊随访。以家庭为基础的随访包括语言翻译、药物递送、对药丸计数依从性的评估、对不良反应的监测以及对不依从患者的主动跟踪。我们评估了在家与在诊所随访的患者在患者特征、治疗完成情况和治疗中止原因方面的差异。多变量分析，以解决可能的转诊偏倚或混淆进行了logistic regression.Results：更多的患者随后与家庭电话完成INH治疗（90%的家庭与73.2%的诊所）。所有患者亚组的情况都是如此，包括历史上依从性最低的患者：来自矫正和康复机构的患者（77.8%家庭vs 46.9%诊所），产后妇女（86.4%家庭vs 55.6%诊所）和年龄在18至35岁之间的患者（87%家庭vs 63.1%诊所）。在调整年龄、出生地、转诊类别（结核病接触者/皮肤试验转换者、矫正/康复患者、产后妇女、其他筛查的结核菌素阳性患者）和规定的INH方案持续时间（9个月与6个月）后，LTBI患者的家庭随访是治疗完成的重要预测因素（AOR 2.94，95%CI：2.33，3.71）。在家中随访的患者完成治疗的可能性高21%（ARR 1.21，p
Background: Patient adherence to isoniazid (INH) monotherapy for latent tuberculosis infection (LTBI) has been suboptimal despite its proven efficacy. Various strategies have been studied to improve adherence, but all have been based at a clinic or treatment program. At the Santa Clara Valley Tuberculosis Clinic, it was our practice to refer a subset of high-risk LTBI patients to the Public Health Department for monthly follow-up at home instead of at the clinic. Our goal was to assess whether house calls by community health workers and public health nurses affected INH adherence or frequency of adverse effects.Methods: We retrospectively studied 3918 LTBI patients who received INH. At the discretion of the treating physician, 986 (25.2%) received house calls instead of clinic follow-up. Home-based follow-up included language translation, medication delivery, assessment of compliance with pill counts, monitoring for adverse effects, and active tracking of noncompliant patients. We assessed differences in patient characteristics, treatment completion, and reasons for treatment discontinuation between patients followed at home versus in the clinic. Multivariate analyses to address possible referral bias or confounding were performed using logistic regression.Results: More patients followed with house calls completed INH treatment (90% home versus 73.2% clinic). This was the case across all subgroups of patients, including those with historically the lowest adherence: patients from correctional and rehabilitation facilities (77.8% home versus 46.9% clinic), postpartum women (86.4% home versus 55.6% clinic), and patients aged between 18 and 35 years (87% home versus 63.1% clinic). After adjusting for age, place of birth, referral category (TB contacts/skin test converters, correctional/rehabilitation patients, postpartum women, tuberculin positive patients from other screening), and prescribed INH regimen duration (9 versus 6 months), home-based follow-up of LTBI patients was a significant predictor of treatment completion (AOR 2.94, 95% CI: 2.33, 3.71). Patients followed at home were 21% more likely to complete therapy (ARR 1.21, p