关键词: 结核,肺, 病例管理, 结果与过程评价(卫生保健), 手机微信APP, 电子药盒

Abstract: Objective: To evaluate the implementation effect of digital treatment adherence technologies (DAT) and further improve the quality of treatment and service management for active pulmonary tuberculosis patients in Changji Prefecture, Xinjiang Uygur Autonomous Region (referred to as “Xinjiang”).Methods: A retrospective study was conducted. Clinical data of active pulmonary tuberculosis patients registered with current addresses in “Changji Prefecture, Xinjiang (5 counties and 2 cities)” from January 1, 2021, to March 31, 2023, were exported from the “Tuberculosis Information Management System” and the “Easy Supervision” website of the Chinese Center for Disease Control and Prevention. Based on the patient management method, 403 patients registered as pulmonary tuberculosis from January 1 to December 31, 2021, but not using the “Easy Supervision” system were included in the traditional management group (traditional group). Additionally, 313 patients registered as pulmonary tuberculosis from January 1, 2022, to March 31, 2023, and using the “Easy Supervision” system were included in the DAT management group (DAT group). The DAT utilization rate was 89.68% (313/349). Further categorization of the DAT group based on the use of electronic tools resulted in the Electronic Medication Box management group (Medication Box group; 81 cases (25.88%)) and the WeChat official account management group (WeChat group; 232 cases (74.12%)). The population demographics, medication adherence, treatment outcomes, DAT usage in the DAT group, and management conditions in different regions were analyzed. Results: The WeChat group had significantly lower proportions in the age group ≥60 years (30.60% (71/232)) and among farmers and herdsmen (40.95% (95/232)) compared to the Medication Box group (77.78% (63/81) and 76.54% (62/81)), and the differences were statistically significant (χ²=54.780, P=0.000; χ²=32.666, P=0.000). The Traditional Group had higher overall medication adherence rates (97.78% (99053/101299)) and regular medication adherence rates (96.03% (387/403)) than the DAT management group (93.23% (62601/67146) and 85.62% (268/313)), the Medication Box group’s overall medication adherence rate (95.89% (15808/16486)) was higher than the WeChat group (92.37% (46793/50660)), and the differences were statistically significant (χ²=2162.210, 24.481, 244.306, all P values=0.000). However, there was no statistically significant difference in regular medication adherence rates between the WeChat group (84.48% (196/232)) and the Medication Box group (88.89% (72/81))(χ²=0.947, P=0.331). The treatment success rate (95.85% (300/313)), sputum examination rate at the end of the 2nd/3rd month (99.36% (311/313)), and sputum smear conversion rate (98.76% (159/161)) in the DAT group were not statistically different from those in the traditional group (94.29% (380/403), 98.26% (396/403), and 97.83% (271/277)), respectively (χ²=0.891, P=0.345; χ²=0.941, P=0.332; χ²=0.106, P=0.744). However, the WeChat group’s treatment success rate (98.28% (228/232)) was higher than that of the Medication Box group (88.89% (72/81)), and the difference was statistically significant (χ²=11.036, P=0.001). The regular medication adherence rates in different regions of the DAT management group ranged from 61.22% (30/49) to 97.30% (36/37), and the difference was statistically significant (χ²=39.320, P=0.000). Conclusion: The proportion of pulmonary tuberculosis patients in Changji Prefecture, Xinjiang, accepting DAT management is relatively high, with WeChat official account management being the primary method. This method can more accurately reflect patient medication conditions, and the management effect is consistent with traditional management methods. Different DAT management measures should be developed for different counties, cities, management methods, ages, and occupational groups in order to improve regular medication adherence rates. The application of DAT should be gradually promoted in Xinjiang.

Key words: Tuberculosis, pulmonary, Case management, Outcome and process assessment (health care), Mobile phone WeChat, Medicine monitor