关键词: 结核,肺, 病例管理, 手机微信, 电子药盒, 效果评价

Abstract:

Objective: To assess and analyze the effectiveness of using WeChat and electronic pillbox to strengthen supervision management for pulmonary tuberculosis (PTB) patients in Beijing, so as to provide basis for the selection of TB patients management tools. Methods: Tongzhou, Changping and Pinggu were selected as pilot districts. PTB patients registered from January 1 to December 31, 2021 in the above districts were screened according to the inclusion criteria. Finally, 515 patients were enrolled in each of the control group and the intelligent tools group (134 patients used WeChat and 381 patients used electronic pillbox). After they completed their treatment course, patients’ adherence(demonstrated as regular check rate for the intelligent tools), treatment effectiveness and satisfaction with E-patient service tools were assessed. Results: Univariable analysis showed that the regular check rate was 12.2% (21/172) in the younger than 30 years old age group, 30.5% (68/223) in the 30 to 60 years old age group, 25.8% (31/120) in the group aged 60 and over, the difference was significant (χ²=18.726, P<0.001). The regular check rate was 19.9% (44/221) among patients with a regular job, 14.1% (9/64) among retired people, 39.7% (31/78) among peasants/herdsmen/fishermen, 10.0% (2/20) among students, 25.8% (34/132) among houseworkers or unemployed patients, the difference was significant (χ²=18.704, P<0.001). The regular check rate of Beijing local patients was 29.9% (69/231), floating patients from other regions was 18.0% (51/284), the difference was significant (χ²=10.115, P=0.002). The regular check rate of patients who were firstly diagnosed in the municipal designated hospital, district-level designated hospital and tuberculosis control agencies were 24.8% (63/254), 76.5% (13/17) and 18.0% (44/244), respectively. The difference was significant (χ²=31.001, P<0.001). The regular check rate was 20.8% (90/433) and 36.6% (30/82) in PTB patients without and with extrapulmonary tuberculosis, respectively. The difference was significant (χ²=9.631,P=0.002). Multivariable logistic regression analysis showed that patients aged 30 to 60 (OR=3.154,95%CI:1.842-5.403) and over 60 years old (OR=2.504,95%CI:1.357-4.622), with Beijing local residence (OR=1.837,95%CI:1.154-2.923), and combined with extrapulmonary tuberculosis (OR=2.596,95%CI:1.532-4.399) could adhere better to use intelligent tools through the whole treatment course. In terms of treatment effectiveness, the treatment success rate were 93.0% (479/515) and 93.2% (480/515) in the control group and intelligent tools group, respectively. The difference was not statistically significant (χ²=0.015, P=0.902). The average treatment duration of successfully treated patients in the intelligent tools group was significantly shorter than the control group (288 (206,365) d vs. 363 (234,365) d, Z=4.981, P<0.001). The 2 or 3 months sputum checking rate and the sputum conversion rate of patients using the two intelligent tools were higher than the control group (58.1% (157/270) and 56.7% (153/270) vs. 42.7% (109/255) and 39.6% (101/255), χ²=12.448, 15.281, both P<0.001). 64.5% (330/512) of patients were satisfied with WeChat/electronic pillbox. Conclusion: WeChat/electronic pillbox ensured treatment success and promoted patients making regular medical visit and taking sputum test. It was suitable to promote these tools among patients aged 30 and over, being Beijing local people and combined with extrapulmonary tuberculosis.

Key words: Tuberculosis, pulmonary, Case management, WeChat APP, Electronic pillbox, Outcome assessment