Analysis of impact factors of medication adherence among patients with sputum smear-positive pulmonary tuberculosis in Wuhan

doi:10.3969/j.issn.1000-6621.2018.02.022

Abstract

Abstract:

A questionnaire survey with simple random sampling was conducted by trained questionnaire surveyors to 356 sputum smear-positive pulmonary TB patients of Wuhan Tuberculosis Prevention and Cure Institute during November 2013 to May 2015. The effective recovery of the questionnaire was 342 with the recovery rate of 96.07%. The status of medication adherence and its impact factors were analyzed. Of 342 patients, 39 patients had poor medication adherence (11.40%), 303 patients had good medication adherence (88.60%). Logistic regression analysis revealed that, compared with the patients joining in the medical insurance for urban workers, patients in medical insurance for urban residents (Wald χ ²=4.37, P=0.044,OR=1.64,95%CI=1.12-3.45), patients in new rural cooperative medical insurance (Wald χ ²=8.13, P=0.013,OR=2.13,95%CI=1.59-3.38) had poorer medication compliance. Patients with poor knowledge of TB had poorer medication compliance (Wald χ ²=5.10, P=0.009,OR=2.70,95%CI=1.65-3.67). This study revealed that insurance type and knowledge of TB are impact factors for TB medication compliance.

Key words: Tuberculosis, pulmonary, Medication adherence, Cognition, Factor analysis, statistical

Zhan LIAN,Ting-ping WANG,Juan DU. Analysis of impact factors of medication adherence among patients with sputum smear-positive pulmonary tuberculosis in Wuhan[J]. Chinese Journal of Antituberculosis, 2018, 40(2): 222-225. doi: 10.3969/j.issn.1000-6621.2018.02.022

Figures/Tables 4

因素	β值	s $x ˉ$ 值	Wald χ²值	P值	OR值(95%CI值)
医疗保险类型
城镇职工医疗保险
城镇居民医疗保险	0.50	0.23	4.37	0.044	1.64(1.12~3.45)
新型农村合作医疗保险	0.76	0.18	8.13	0.013	2.13(1.59~3.38)
其他医疗保险	0.12	0.15	3.74	0.062	1.12(0.42~2.01)
对疾病的认知
认为症状消失后应继续服药
认为可以停止服药	1.00	0.35	5.10	0.009	2.70(1.65~3.67)

References 19

[1]	World Health Organization . Global tuberculosis report 2017. Geneva: World Health Organization, 2017.
[2]	Jin J, Sklar GE, Min Sen OH V , et al. Factors affecting thera-peutic compliance: A review from the patient’s perspective. Ther Clin Risk Manag, 2008,4(1):269-286. doi: 10.2147/TCRM URL
[3]	郑玉群, 王建明, 周杨 , 等. 江苏省涂阳肺结核患者治疗依从性现状调查及影响因素分析. 南京医科大学学报(自然科学版), 2009,29(10):1384-1388. doi: 10.7655 URL
[4]	Fagundez G, Perez-Freixo H, Eyene J , et al. Treatment adherence of tuberculosis patients attending two reference units in Equatorial Guinea. PLoS One, 2016,11(9):e0161995. doi: 10.1371/journal.pone.0161995 URL pmid: 27622461
[5]	王宇, 方群 . 机关门诊部诊治的流动人口肺结核患者的治疗依从性影响因素分析. 中国防痨杂志, 2016,38(11):985-989. doi: 10.3969/j.issn.1000-6621.2016.11.018 URL
[6]	Thiam S LeFevre AM, Hane F , et al. Effectiveness of strategy to improve adherence to tuberculosis treatment in a resource-poor setting: a cluster randomized controlled trial. JAMA, 2007,297(4):380-386. doi: 10.1001/jama.297.4.380 URL
[7]	李向群, 梅建, 夏珍 . 333例结核病患者不规则治疗原因与转归分析. 中国防痨杂志, 2006,28(6):379-381. doi: 10.3969/j.issn.1000-6621.2006.06.012 URL
[8]	方雪晖, 姚嵩, 史四九 , 等. 中国偏远地区涂阳肺结核患者治疗依从性影响因素分析. 中国农村卫生事业管理, 2012,32(12):1262-1264.
[9]	李珊, 刘兆炜, 李志新 , 等. 自贡市结核病患者依从性现状及影响因素调查. 预防医学情报杂志, 2012,28(9):698-701.
[10]	陈玮, 杨早, 雷世光 , 等. 贵州省山区涂阳肺结核患者治疗依从性及现状影响因素分析. 现代预防医学, 2012,39(15):3948-3950.
[11]	Kaona FA, Tuba M, Siziya S , et al. An assessment of factors contributing to treatment adherence and knowledge of TB transmission among patients of TB treatment. BMC Public Health, 2004,29(4):68.
[12]	Shargie EB, Lindtjørn B . Determinants of treatment adherence among smear-positive pulmonary tuberculosis patients in Southern Ethiopia. PLoS Med, 2007,4(2):e37. doi: 10.1371/journal.pmed.0040037 URL
[13]	Mateus-Solarte JC, Carvajal-Barona R . Factors predictive of adherence to tuberculosis treatment, Valle del Cauca, Colombia. Int J Tuberc Lung Dis, 2008,12(5):520-526. doi: 10.1258/ijsa.2007.007327 URL pmid: 18419887
[14]	宋涛, 曾华志, 梁志强 , 等. 耐多药肺结核服药管理模式对患者服药依从性的效果研究. 结核病与肺部健康杂志, 2017,6(2):148-152. doi: 10.3969/j.issn.2095-3755.2017.02.016 URL
[15]	姜世闻 . 应用创新方法管理肺结核患者治疗提高服药依从性. 中国防痨杂志, 2017,39(7):673-676. doi: 10.3969/j.issn.1000-6621.2017.07.001 URL
[16]	秦志华, 施军卫, 邱青 , 等. 195例耐多药肺结核患者治疗依从性及影响因素分析. 结核病与肺部健康杂志, 2016,5(4):283-287. doi: 10.3969/j.issn.2095-3755.2016.04.008 URL
[17]	尹伟, 张忆群, 郑长峰 . 实施国家基本药物制度的实践与思考. 卫生经济研究, 2011,27(4):11-12. doi: 10.3969/j.issn.1004-7778.2011.04.004 URL
[18]	赵颖, 罗兴能, 李廷荣 , 等. 城市与农村肺结核患者就医行为和治疗依从性调查. 重庆医学, 2013,42(5):529-532.
[19]	郦桂青, 高翠南, 何庆秋 , 等. 肺结核患者治疗依从性的研究进展. 中国防痨杂志, 2010,32(9):585-588.

变量	赋值
年龄	17~岁=1;25~岁=2;35~岁=3;45~岁=4;55~岁=5;>65岁=6
服药方式	自服药=1;他人督导=2
职业	农民=1;工人=2;教师公务员=3;学生=4;退休=5;其他^a=6
文化程度	小学及以下=1;初中=2;高中=3;大学及以上=4
医疗保险类型	城镇职工医疗保险=1;城镇居民医疗保险=2;新型农村合作医疗保险=3;其他医疗保险^b=4
对疾病的认知	认为症状消失后应继续服药=1;认为可以停止服药=2

影响因素	规则治疗(303例)		不规则治疗(39例)		χ²值	P值
影响因素	例数	构成比(%)	例数	构成比(%)	χ²值	P值
年龄(岁)					11.95	0.036
17~	33	10.89	10	25.64
25~	72	23.77	8	20.51
35~	53	17.49	5	12.82
45~	68	22.44	5	12.82
55~	37	12.21	2	5.13
>65	40	13.20	9	23.08
服药方式					5.51	0.019
自服药	200	66.01	33	84.62
他人督导	103	33.99	6	15.38

影响因素	规则治疗(303例)		不规则治疗(39例)		χ²值	P值
影响因素	例数	构成比(%)	例数	构成比(%)	χ²值	P值
职业					16.39	0.006
农民	44	14.52	14	35.90
工人	55	18.15	9	23.08
教师公务员	33	10.89	1	2.56
学生	32	10.56	5	12.82
退休	53	17.49	2	5.13
其他^a	86	28.39	8	20.51
文化程度					7.30	0.063
小学及以下	74	24.42	15	38.46
初中	80	26.41	12	30.77
高中	74	24.42	9	23.08
大学及以上	75	24.75	3	7.69
医疗保险类型					10.31	0.016
城镇职工医疗保险	130	42.91	8	20.51
城镇居民医疗保险	73	24.09	9	23.08
新型农村合作医疗保险	51	16.83	13	33.33
其他医疗保险^b	49	16.17	9	23.08
患者对疾病的认知					10.38	0.001
认为应该继续服药	252	83.17	24	61.54
认为可以停止服药	51	16.83	15	38.46