Are free anti-tuberculosis drugs enough? An empirical study from three cities in China.
Are free anti-tuberculosis drugs enough? An empirical study from three cities in China.
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DOI：
10.1186/s40249-015-0080-y
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发表时间：
2015-10-28
影响因子：
8.1
通讯作者：
Lucas H
中科院分区：
文献类型：
--
作者：
Chen S;Zhang H;Pan Y;Long Q;Xiang L;Yao L;Lucas H
中国的结核病患者在寻求诊断和治疗方面仍然面临着一些障碍。有证据表明，结核病患者及其家庭的经济负担阻碍了治疗依从性。对中国所在的三个城市进行了横断面研究。患者是通过农村乡镇或城市街道的概率与大小成比例(PPS)的整群抽样来选择的，然后从患者登记册中进行列表抽样。数据是通过问卷调查、关键信息者访谈和与结核病患者的焦点小组讨论来收集的，以了解结核病的经济负担以及这种负担对治疗依从性的影响。共有797名结核病患者接受了调查，其中60人在调查后进行了深入采访。超过一半的人有灾难性的医疗支出。家庭收入越高的结核病患者报告不遵从性的可能性越小(OR 0.355，95%CI 0.140-0.830)，而认为与结核病治疗相关的经济负担较高的患者报告不遵从性的可能性更大(OR 3.650，95%CI 1.278-12.346)。那些交通、住宿和食物成本高的人也更有可能报告不遵守规定(OR 4.150，95%CI 1.804-21.999)。定性研究的结果支持了调查的结果。在中国，与寻求诊断和治疗相关的经济负担仍然是结核病患者的障碍。降低治疗成本，并为患者提供交通、住宿和食物补贴，可能会提高治疗依从性。完善医生薪酬制度，切断以收入为导向的激励机制，扩大现行保险覆盖面，有助于减轻患者的实际负担或预期负担。这个问题还需要进一步的研究。本文的在线版本(doi：10.1186/s40249-0150080-y)包含补充材料，授权用户可以使用。
Tuberculosis (TB) patients in China still face a number of barriers in seeking diagnosis and treatment. There is evidence that the economic burden on TB patients and their households discourages treatment compliance. A cross-sectional study was conducted in three cities of China. Patients were selected using probability proportional to size (PPS) cluster sampling of rural townships or urban streets, followed by list sampling from a patient register. Data were collected using a questionnaire survey, key informant interviews and focus group discussions with TB patients to gain an understanding of the economic burden of TB and implications of this burden for treatment compliance. A total of 797 TB patients were surveyed, of which 60 were interviewed in-depth following the survey. More than half had catastrophic health expenditure. TB patients with higher household incomes were less likely to report non-compliance (OR 0.355, 95 % CI 0.140–0.830) and patients who felt that the economic burden relating to TB treatment was high more likely to report non-compliance (OR 3.650, 95 % CI 1.278–12.346). Those who had high costs for transportation, lodging and food were also more likely to report non-compliance (OR 4.150, 95 % CI 1.804–21.999). The findings from the qualitative studies supported those from the survey. The economic burden associated with seeking diagnosis and treatment remains a barrier for TB patients in China. Reducing the cost of treatment and giving patients subsidies for transportation, lodging and food is likely to improve treatment compliance. Improving doctors’ salary system to cut off the revenue-oriented incentive, and expanding current insurance’s coverage can be helpful to reduce patients’ actual burden or anticipated burden. Future research on this issue is needed. The online version of this article (doi:10.1186/s40249-015-0080-y) contains supplementary material, which is available to authorized users.