Effect of “trinity” care service on the multidrug-/rifampicin-resistant tuberculosis patients in the intensive phase

doi:10.19982/j.issn.1000-6621.20220281

Abstract

Abstract:

Objective: To analyze the effect of “trinity” care service on the multidrug-/rifampicin-resistant tuberculosis (MDR/RR-TB) patients in the intensive phase. Methods: A retrospective cohort study was conducted in the MDR/RR-TB patients diagnosed in Xi’an Chest Hospital. A total of 223 MDR/RR-TB patients diagnosed from March 2018 to February 2019 who were under the integrated prevention and control service management model combining hospitalization and community treatment were selected as the control group. A total of 253 MDR/RR-TB patients diagnosed from March 2019 to February 2020 who were implemented the “trinity” care service management model were selected as the intervention group. The treatment adherence and the rate of loss to follow-up between the two groups in the intensive phase were analyzed and compared. Results: The proportion of patients with good treatment adherence in the intervention group was 86.6% (219/253), higher than that in the control group (54.7% (122/223)), the difference was statistically significant (χ²=59.189, P<0.001). The proportion of patients with good injection treatment adherence in the intervention group was 89.8% (221/246), higher than that in the control group (60.6% (134/221)), the difference was statistically significant (χ²=54.460, P<0.001). The rate of loss to follow-up of the intervention group in the intensive phase was 6.3% (16/253), lower than that in the control group (30.9% (69/223)), the difference was statistically significant (χ²=48.970, P<0.001). Conclusion: The implementation of the “trinity” care service management model for MDR/RR-TB patients is helpful to improve the treatment adherence and reduce the rate of loss to follow-up, which is worthy of popularization and application.

Key words: Tuberculosis, multi-drug resistant, Health services, Models, organizational

CLC Number:

R52
S481+.4

He Xiaomou, Luo Hui, Ma Jinbao, Ren Fei, Zhao Ali, Yuan Rong. Effect of “trinity” care service on the multidrug-/rifampicin-resistant tuberculosis patients in the intensive phase[J]. Chinese Journal of Antituberculosis, 2023, 45(1): 104-110. doi: 10.19982/j.issn.1000-6621.20220281

Figures/Tables 4

管理模式	综合防治服务管理模式(对照组)	“三位一体”的关怀服务管理模式(干预组)
定点医院服务措施	患者先住院2周至2个月,住院期间由医生制定耐多药方案,医护共同提供健康教育、心理疏导。出院后由责任护士在患者出院后的第1、3、12个月进行电话随访	患者住院期间的健康教育和治疗与“对照组”相同,同时进行以一对一咨询服务为途径的治疗依从性支持。出院前出具《出院通知单》向社区转介患者,专人对接落实社区注射和督导服药;出院后每月电话预约复诊并提供门诊随访咨询
基层卫生机构服务措施	电话随访服药情况并追踪失访患者	电话随访服药情况,必要时行直接面视下督导管理;追踪失访患者;设立符合感染控制要求的注射室,提供免费注射服务;提供不良反应的监测服务、情感支持、同伴支持及每月随访后发放200元的营养、交通补助;并督导患者定期复查
疾病预防控制中心服务措施	负责疫情监测,对基层卫生机构进行监督培训	组建关怀服务团队,制定关怀服务流程;通过培训咨询员和同伴志愿者,改善基层医疗机构服务设施建设及安装“MDR/RR-TB个案管理系统”来提升各部门关怀能力;协调患者注射治疗服务并开展社区动员与反歧视培训
加强医防合作,融合“三位一体”	疾病预防控制中心组织基层卫生机构追踪失访患者并且每季度召开服务质量分析会	定点医院和疾病预防控制中心、基层卫生机构三方协作追踪失访患者;定点医院为基层卫生机构提供技术支持;通过“医防沟通群”及“MDR/RR-TB个案管理系统”实施信息共享(患者的治疗情况)与双向反馈,及时反馈问题并及早干预;关怀团队每季度召开MDR/RR-TB防治服务质量分析会,完善服务流程

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一般情况	对照组(223例)		干预组(253例)		χ²值	P值
一般情况	例数	构成比(%)	例数	构成比(%)	χ²值	P值
性别					0.458	0.550
男性	158	70.9	172	68.0
女性	65	29.1	81	32.0
年龄(岁)					1.160	0.560
7~18	14	6.3	14	5.5
19~59	186	83.4	205	81.1
60~85	23	10.3	34	13.4
文化程度					6.625	0.085
文盲	6	2.7	10	4.0
小学及初中	84	37.7	113	44.7
高中及中专	75	33.6	59	23.3
大专及以上	58	26.0	71	28.0
职业					2.132	0.545
农民	92	41.3	104	41.1
职工	74	33.1	91	36.0
学生	24	10.8	18	7.1
无业及其他	33	14.8	40	15.8
家庭经济收入(元/月)					0.380	0.827
<3000	46	20.6	50	19.8
3000~5000	120	53.8	132	52.1
>5000	57	25.6	71	28.1
患者类型					0.789	0.402
初治	125	56.1	152	60.1
复治	98	43.9	101	39.9
医疗费用支付方式					0.268	0.414
医疗保险	217	97.3	248	98.0
自费	6	2.7	5	2.0
合并症					0.023	0.903
有	37	16.6	54	21.3
无	186	83.4	199	78.7
治疗方案含注射剂					1.731	0.200
是	221	99.1	246	97.2
否	2	0.9	7	2.8
注射时长(月)					0.453	0.051
4~6	2	0.9	1	0.4
7~8	219	99.1	245	99.6
住院时长(月)					1.018	0.384
<2	215	96.4	239	94.5
≥2	8	3.6	14	5.5

治疗情况	对照组(223例)	干预组(253例)	χ²值	P值
服药依从性			59.189	<0.001
好	122(54.7)	219(86.6)
差	101(45.3)	34(13.4)
注射剂治疗依从性^a			54.460	<0.001
好	134(60.6)	221(89.8)
差	87(39.4)	25(10.2)
失访			48.970	<0.001
是	69(30.9)	16(6.3)
否	154(69.1)	237(93.7)

注射治疗实施情况	对照组	干预组	χ²值	P值
社区治疗期需继续注射剂治疗^a			41.911	<0.001
继续治疗	150(69.1)	225(92.6)
未继续治疗	67(30.9)	18(7.4)
注射地点^b			133.844	<0.001
私人诊所	87(58.0)	27(12.0)
社区卫生服务中心/乡镇卫生院	14(9.3)	118(52.4)
家	16(10.7)	5(2.2)
村医	6(4.0)	37(16.5)
定点医院注射门诊	27(18.0)	38(16.9)
支付注射费用^b			86.871	<0.001
是	129(86.0)	84(37.3)
否	21(14.0)	141(62.7)
注射时与其他患者隔离^b			105.932	<0.001
是	78(52.0)	217(96.4)
否	72(48.0)	8(3.6)
中断注射剂治疗^b			14.085	<0.001
是	16(10.7)	4(1.8)
否	134(89.3)	221(98.2)