Doctors' compliance with national guidelines and clinical pathway on the treatment of tuberculosis inpatients in Hubei, China
Doctors' compliance with national guidelines and clinical pathway on the treatment of tuberculosis inpatients in Hubei, China
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DOI：
10.1111/jep.12127
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发表时间：
2014-06-01
影响因子：
2.4
通讯作者：
Zhang, Xinping
中科院分区：
文献类型：
--
作者：
Zheng, Xiaofei;Zhong, Fangying;Zhang, Xinping
基本原理、目的和目标中国卫生部颁布了修订后的国家结核病控制规划（NTP）指南和临床路径（CP），以提高结核病护理质量，并要求医生在治疗结核病住院患者时遵守这些指南和路径。然而，医生们是否能很好地遵守这些规定仍不得而知。因此，本研究的重点是在一家具有代表性的结核病医院对医生的依从性进行评估，以提高医疗质量。方法对2011年7月至2013年7月住院的所有新诊断痰阳性肺结核患者的病历进行回顾性分析。选择适当的药物方案率、适当的药物剂量率和适当的住院时间率等分析指标来评估医生对国家结核控制项目指南和新发涂阳肺结核住院患者治疗方案的遵守情况。这些指标的最优值为100%。结果入选的334例住院患者中，处方用药方案合规率为26.95%(90/334)，用药剂量合规率为0%（0/90）。单药用量方面，异烟肼、利福平、吡嗪酰胺和乙胺丁醇的适用量率分别为24.44%（22/90）、85.56%（77/90）、70%（63/90）和13.33%（12/90）。异烟肼处方过高的占75.56%(68/90)，乙胺丁醇处方过低的占83.34%（75/90）。提供足够住院时间的比率为28.44%（95/334）。结论医生对新发涂阳肺结核住院患者对国家结核控制规划指南和诊疗方案的依从性较低，需要改善。
Rationale, aims and objectivesThe Ministry of Health in China has enacted a revised National Tuberculosis Control Program (NTP) guidelines and clinical pathway (CP) on new smear-positive pulmonary tuberculosis (TB) inpatients to improve the quality of TB care and asked doctors' compliance to them on the treatment of TB inpatients. However, it remains unknown whether doctors adhere to them well. So this study focuses on evaluating the doctors' compliance with them in one representative TB hospital for medical quality improvement.MethodsA hospital-based retrospective study involving all medical records of newly diagnosed smear-positive pulmonary TB inpatients from July 2011 to July 2013. Analysis indicators including adequate drug regimens rate, adequate drug dosages rate and adequate length of hospital stay rate were chosen to assess doctors' compliance with NTP guidelines and CP on the treatment of new smear-positive pulmonary TB inpatients. The optimal value of these indicators is 100%.ResultsOf the 334 inpatients selected, the rate of adequate drug regimens prescribed is 26.95% (90/334), and the rate of adequate drug dosages is 0% (0/90). For the dosage of single drug, the rates of adequate dosage of isoniazid, rifampicin, pyrazinamide and ethambutol are 24.44% (22/90), 85.56% (77/90), 70% (63/90) and 13.33% (12/90). Moreover, 75.56% (68/90) of isoniazid was prescribed too high and 83.34% (75/90) of ethambutol was prescribed too low. The rate of adequate length of hospital stay provided is 28.44% (95/334).ConclusionDoctors' compliance with NTP guidelines and CP on new smear-positive pulmonary TB inpatients is depressed and needs improvement.