电子药盒和手机微信APP 对肺结核患者督导服药管理的应用研究

doi:10.3969/j.issn.2096-8493.2020.01.020

摘要/Abstract

摘要：

济南市长清区和济阳区作为中国疾病预防控制中心开展的 “肺结核患者使用智能化电子药盒和手机微信APP治疗管理系统适用性研究”的试点现场,从结核病定点医院按照入组标准顺位纳入2017年9月1日至2018年3月15日期间新登记且知情同意的60例初治活动性肺结核患者[每区20例使用智能化电子药盒(药盒组),10例使用手机微信APP(微信组)],开展6个月的前瞻性督导服药管理研究,记录并分析患者使用智能化电子药盒和手机微信APP的服药、复诊情况和医务人员的访视情况。结果显示,药盒组和微信组的总体服药率[92.62%(3841/4147)和96.59%(3281/3397)] 和复诊率[94.59%(175/185)和99.09%(109/110)]均较高,且差异均有统计学意义(χ²=205.37,P=0.000;χ²=3.89,P=0.049),说明两组绝大多数患者对服药和复诊的依从性均较好,且微信组优于药盒组。而医务人员对药盒组和微信组的总体访视率[41.99%(139/331)和53.14%(110/207)]均较低,且差异有统计学意义(χ²=6.37,P=0.012),说明两组患者的总体访视效果不佳,有待提高。

关键词: 结核,肺, 病人医护管理, 计算机通信网络, 病人依从, 药物治疗依从性, 结果与过程评价(卫生保健)

Abstract:

Changqing District and Jiyang District of Ji’nan are the pilot sites of the “Study on the Applicability of the Use of Intelligent Electronic Pillboxes and Mobile WeChat App Management System for Pulmonary Tuberculosis Patients” conducted by the Chinese Center for Disease Control and Prevention. According to inclusion criteria, 60 newly registered primary active pulmonary tuberculosis patients with informed consent between September 1, 2017 and March 15, 2018 from tuberculosis designated hospital were sequentially included (20 patients used intelligent electronic kits (pillbox group), 10 cases used mobile WeChat APP (WeChat group) in each district. A 6-month prospective supervision medication management study was conduct, the use of intelligent electronic pillboxes and mobile WeChat APP for medication management, return visit and the follow up by medical staff were recorded and analyzed. The results showed that the overall medication rate and the rate of return visit of the electronic pill box group were significantly lower than those of the WeChat group (92.62% (3841/4147) vs. 96.59% (3281/3397), χ²=205.37, P=0.000; 94.59% (175/185) vs. 99.09% (109/110), χ²=3.89, P=0.049) although all the rates were high. It indicated that majority of the patients in the two groups had good compliance with medication and return visit, and data of WeChat group were better than those of pillbox group. The overall rate of follow up by medical staff were low in both two groups, and the rate in pillbox group was significantly lower than that in WeChat group (41.99% (139/331) vs.53.14% (110/207), χ²=6.37, P=0.012). The overall rate of follow up was poor and needed to be improved.

Key words: Tuberculosis, pulmonary, Patient care management, Computer communication networks, Patient compliance, Medication adherence, Outcome and process assessment (health care)

景睿, 曹艳民, 杨一军, 武鸿燕, 蔡俊丽, 任雯, 张文茜, 王美花. 电子药盒和手机微信APP 对肺结核患者督导服药管理的应用研究[J]. 结核与肺部疾病杂志, 2020, 1(1): 96-99. doi: 10.3969/j.issn.2096-8493.2020.01.020

JING Rui, CAO Yan-min, YANG Yi-jun, WU Hong-yan, CAI Jun-li, REN Wen, ZHANG Wen-qian, WANG Mei-hua. A study of application of electronic pillbox and mobile WeChat APP on pulmonary tuberculosis patient supervision and management of taking medication[J]. Journal of Tuberculosis and Lung Disease, 2020, 1(1): 96-99. doi: 10.3969/j.issn.2096-8493.2020.01.020

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组别	未使用患者例数
组别	第1个月	第2个月	第3个月	第4个月	第5个月	第6个月
药盒组(40例)	0	5	10	12	16	23
微信组(20例)	0	0	0	1	2	3

原因	合计	药盒组	微信组	χ²值	P值
患者拒绝随访	57(19.72)	32(16.93)	25(25.00)	2.69	0.101
村医工作忙	58(20.07)	31(16.40)	27(27.00)	4.58	0.044
医生未添加随访	31(10.73)	11(5.82)	20(20.00)	13.73	0.000
患者未按确认随访键	86(29.76)	70(37.04)	16(16.00)	13.85	0.000
与患者联系不通	15(5.19)	6(3.17)	9(9.00)	4.51	0.034
患者外出	15(5.19)	15(7.94)	0(0.00)	8.37	0.004
患者住院	2(0.69)	2(1.06)	0(0.00)	1.07	0.302
年龄大不便配合	12(4.15)	12(6.35)	0(0.00)	6.60	0.010
药盒或微信APP离线	4(1.38)	4(2.12)	0(0.00)	2.14	0.302
原因不详	9(3.12)	6(3.17)	3(3.00)	0.01	1.000
合计	289(100.00)	189(100.00)	100(100.00)