关键词: 结核,肺, 病例管理, 因素分析,统计学, 中断治疗

Abstract:

Objective: To analyze the interruption of treatment and influencing factors in 317 patients with pulmonary tuberculosis,then propose countermeasures to provide basis for improving the management quality of tuberculosis patients. Methods: All of 2715 pulmonary tuberculosis patients were taken as the research objects, who were registered and managed in Tuberculosis Outpatient Department of Beijing Center for Disease Control and Prevention from 2012 to 2021. Basic demographic information and clinical data was collected from Tuberculosis Management Information System and medical records respectively. Univariate and multivariate logistic regression methods were used to analyze the influencing factors of treatment interruption. Results: Among 2715 pulmonary tuberculosis patients, 317 cases were interrupted treatment, with a rate of 11.68%. Univariate analysis showed that the interrupted treatment rate of female patients (10.11%, 109/1078) was lower than that of male patients (12.71%, 208/1637), and there was significant difference (χ²=4.244,P=0.039).The interrupted treatment rate of patients in 25-44 years old group (8.21%, 96/1170) was lower than that in <25 years old group (11.38%, 57/501), 45-64 years old group (14.75%, 86/583) and ≥65 years old group (16.92%, 78/461), and the difference was significant (χ²=31.349,P<0.01).In occupational classification, the interrupted treatment rate for tuberculosis patients with occupations as students/teachers/medical personnel/cadres (7.29%, 72/988) was lower than that of patients with occupations as farmers/migrant workers/workers (13.37%, 25/187), retired/housework and unemployed/other (14.65%, 194/1324), and commercial, catering service/public place waiters (12.04%, 26/206) and the difference was statistically significant (χ²=30.373,P<0.001).The interrupted treatment rate of initially treated pulmonary tuberculosis patients (11.05%, 274/2480) was lower than that in retreated pulmonary tuberculosis patients (18.30%, 43/235), and the difference was statistically significant (χ²=10.939,P<0.001). Multivariate analysis showed that comparing with patients aged 25-44 years, patients aged <25 years (OR=1.536, 95%CI: 1.082-2.180), patients aged 45-64 years (OR=1.538, 95%CI: 1.101-2.149) and patients aged ≥65 years (OR=1.596, 95%CI: 1.095-2.326) were more likely to interrupt treatment.Comparing with students/teachers/medical staff/cadres, commercial, catering service/public place waiters (OR=1.693, 95%CI: 1.050-2.731), farmers/migrant workers/workers (OR=1.681, 95%CI: 1.014-2.787), retired/housework and unemployed/other occupation (OR=1.776, 95%CI: 1.278-2.469) were more likely to interrupt treatment. Treatment interruption was more likely to occur in retreated patients than in initial patients (OR=1.487, 95%CI: 1.031-2.145).54.57% (173/317) of tuberculosis patients interrupted treatment within the first 2 months of treatment. Conclusion: Beijing should adopt more targeted supervision and health education for male, retired/housework and unemployed/other, older people ≥65 years old, and retreated patients with pulmonary tuberculosis. Management of the first two months of treatment should be strengthened to reduce the rate of treatment interruption.

Key words: Tuberculosis, pulmonary, Case management, Factor analysis, statistical, Treatment interruption