What are the reasons for patients not adhering to their anti-TB treatment in a South African district hospital?
What are the reasons for patients not adhering to their anti-TB treatment in a South African district hospital?
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DOI：
10.1080/20786204.2009.10873916
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发表时间：
2009-01-01
影响因子：
1
通讯作者：
Mash, R.
中科院分区：
文献类型：
--
作者：
Govender, S.;Mash, R.
简介：结核病是南非的一个主要健康问题，通报的患者数量不断增加，治疗成功率不足，以及新出现的耐药菌株问题。这项研究是在夸祖鲁-纳塔尔的一家地区医院进行的，那里的治疗成功率低至23%。这项研究的目的是找出医院可能影响结核病治疗依从性的关键因素，并推荐可以提高依从性的干预措施。方法：研究设计为病例对照研究，使用前瞻性收集的数据。根据影响结核病依从性的已知因素，在患者开始抗结核治疗的8个月内收集了信息。然后对患者进行随访，以确定哪些人没有坚持他们的治疗，哪些人成功地完成了治疗。因此，涉及的两组是对照组(坚持的人)和病例(不坚持的人)。结果：共获得159例肺结核患者的数据，105例(66%)为粘连性肺结核，54例(34%)为非粘附性肺结核。以下变量与不遵守规定有显著关联(p<；0.05)：较高的教育水平；离医院的距离；旅行时间；交通工具；对医院的满意度；食品安全；收入；吸烟和/或大麻；患者的观点和信念；艾滋病毒检测和状况；功能状况；社会支持；与结核病护士的关系；抑郁评分；和自信的自我评估。Logistic逐步回归分析显示，只有旅行时间(OR7.9，95%CI 1.4~44.1)和与结核病护士的关系(OR2.6，95%CI 1.3~5.1)两个变量仍有统计学意义。结论：建议通过沟通技能培训改善病人与护士之间的关系。对患者进行更全面的评估将有助于识别抑郁症等问题，而更以患者为中心的方法将有助于理解和解决患者的担忧、信念和期望。同样重要的是，确保管理和行政系统支持更加以病人为中心的方法。鼓励招聘受过沟通技能培训和以病人为中心的家庭医生到农村地区工作，在那里他们可以指导和教导其他同事和工作人员，这一点可能很重要。需要做更多的工作，以帮助患者通过交通工具使用设施，或通过DOTS(直接观察治疗)支持者和适当的居家照顾者支持，在社区一级更容易获得服务。
Introduction: TB is a major health problem in South Africa, with increasing numbers of patients notified, inadequate successful treatment rates and an emerging problem with resistant strains. This study was conducted at a District Hospital in KwaZulu-Natal where the successful treatment rate was as low as 23%. The aim of this study was to identify key factors at the hospital that may affect adherence to TB treatment and to recommend interventions that could improve adherence.Methods: The study design was a case control study using prospectively collected data. Information was collected over an 8-month period, when the patients started their anti-TB treatment, according to the known factors that influence TB adherence. The patients were then followed up to determine those who did not adhere to their treatment, and those who successfully completed treatment. The two groups involved, therefore, were the controls (those who did adhere) and the cases (those who did not adhere). The data previously collected were then compared for significant associations with the controls and cases.Results: Data were obtained from 159 TB patients, 105 (66%) were adherent and 54 (34%) non-adherent. The following variables showed a significant association (p < 0.05) with non-adherence: higher level of education; distance from the hospital; time taken to travel; the method of transport; satisfaction with the hospital; food security; income; the smoking of tobacco and/or marijuana; the patients' perspective and beliefs; HIV testing and status; functional status; social support; the relationship with the TB nurse; depression score; and self-rating of confidence. A stepwise logistic regression was performed, and only two variables remained significantly associated: travel time (OR7.9, 95% CI 1.4-44.1) and the relationship with the TB nurse (OR2.6, 95% CI 1.3-5.1).Conclusions: The most important recommendation is to improve the relationship between patients and TB nurses through training in communication skills. A more holistic assessment of patients would help identify issues such as depression, and a more patient-centred approach would help to understand and address patient's concerns, beliefs and expectations. It may also be important to ensure that management and administrative systems support a more patient-centred approach. It may be important to encourage the recruitment of family physicians who are trained in communication skills and a patient-centred approach, to work in the rural areas, where they can mentor and teach other colleagues and staff. More needs to be done in terms of helping patients to access facilities through transport, or in making services more available at the community level through DOTS (Directly Observed Treatment) supporters and adequate home-based carer support.