DOTS联合微信管理方式对肺结核患者治疗管理效果的评价

doi:10.3969/j.issn.2096-8493.2021.01.011

结核与肺部疾病杂志 ›› 2021, Vol. 2 ›› Issue (1): 50-53.doi: 10.3969/j.issn.2096-8493.2021.01.011

DOTS联合微信管理方式对肺结核患者治疗管理效果的评价

李源¹(), 高风华¹, 金锋²()

¹255026 山东省淄博市疾病预防控制中心结核病防制所(李源、高风华)
²山东省公共卫生临床中心(山东大学附属山东省胸科医院) 山东省传染性呼吸疾病重点实验室(金锋)

收稿日期:2020-12-03 出版日期:2021-03-30 发布日期:2021-03-24
通信作者: 李源,金锋 E-mail:zblyy.7777@163.com;2547875348@qq.com
基金资助:
山东省医药卫生科技发展计划(2017WS163)

Evaluation of treatment and management effect of DOTS combined with WeChat on pulmonary tuberculosis patients

LI Yuan¹(), GAO Feng-hua¹, JIN Feng²()

¹Tuberculosis Control Institute, Zibo Center for Disease Control and Prevention, Zibo 255026, China
²Shandong Public Health Clinical Center; Shandong Provincial Chest Hospital, Shandong University; Shandong Provincial Key Laboratory of Infectious Respiratory Diseases, Ji’nan 250013, China

Received:2020-12-03 Online:2021-03-30 Published:2021-03-24
Contact: LI Yuan,JIN Feng E-mail:zblyy.7777@163.com;2547875348@qq.com

摘要/Abstract

摘要：

目的评价直接面视下短程督导化疗(directly observed treatment short curse, DOTS)联合微信管理方式在肺结核患者治疗管理中的应用效果。方法选取2018年1月1日至2019年12月31日淄博市登记的符合研究纳入标准的活动性肺结核患者1988例作为研究对象。根据随机数字表法及知情同意原则,分为DOTS+微信管理患者(DOTS+微信组;836例)和单一DOTS管理患者(DOTS组;1152例),比较两组患者的规则服药情况、治疗及转归情况(痰菌检查次数符合率、2个月末痰菌阴转率、成功治疗率)、治疗管理情况(督导管理率、随访管理率)。结果 DOTS组患者规则服药率[92.10%(1061/1152)]明显低于DOTS+微信组[98.80%(826/836)],差异有统计学意义(χ²=45.138,P<0.001)。在治疗与转归方面,DOTS组初始病原学阳性患者2个月末的痰菌阴转率[95.82%(436/455)]与DOTS+微信组 [97.44%(343/352)]比较,差异无统计学意义(χ²=1.553,P=0.213);治疗结束时,DOTS组的痰检次数符合率[90.19%(1039/1152)]和成功治疗率[96.53%(1112/1152)]均明显低于DOTS+微信组[分别为95.81%(801/836)和98.68%(825/836)](χ²=22.230,P<0.001;χ²=9.013,P=0.003)。在督导随访管理方面,两组患者的督导管理率均为100.00%,其中DOTS组医务人员直接督导管理率[75.87%(874/1152)]明显低于DOTS+微信组[100.00%(836/836)],差异有统计学意义(χ²=17.330,P<0.001);DOTS组患者巩固期、全疗程的完整随访率[分别为98.35%(1133/1152)和98.09%(1130/1152)]均低于DOTS+微信组[分别为100.00%(836/836)和99.76%(834/836)],差异均有统计学意义(χ²=13.921,P<0.001;χ²=11.335,P=0.001)。结论 DOTS联合微信管理方式对肺结核患者的治疗管理优于单一DOTS管理方式,是一种可行且有效的患者管理方式。

关键词: 结核, 肺, 病例管理, 微信, 结果与过程评价(卫生保健)

Abstract:

Objective To evaluate the application effect of directly observed treatment short curse (DOTS) combined with WeChat in the treatment and management of tuberculosis patients. Methods From January 1, 2018 to December 31, 2019, a total of 1988 registered active pulmonary tuberculosis patients meeting the inclusion criteria in Zibo were enrolled. According to the principle of informed consent, they were dived into DOTS+WeChat group (n=836) and single DOTS group (n=1152) cases were treated with management. The regular medication, treatment and outcome (the coincidence rate of sputum test times, the sputum negative conversion rates at the end of 2 months, the success rate of treatment), and patient management (the rate of supervision management and follow-up management) of the two groups were compared. Results The regular medication rate of single DOTS was statistically lower than that of DOTS+WeChat group (92.10% (1061/1152) vs. 98.80% (826/836); χ²=45.138, P<0.001). In terms of treatment and outcome, there was no significant difference between the two groups, the sputum negative conversion rates at the end of 2 months were 95.82% (436/455) in the single DOTS group and 97.44% (343/352) in the DOTS+WeChat group (χ²=1.553, P=0.213). The coincidence rate of sputum test times and the success rate of treatment in the DOTS+WeChat group were both significantly higher than those in the single DOTS group (95.81% (801/836) vs. 90.19% (1039/1152), χ²=22.230, P<0.001; 98.68% (825/836) vs. 96.53% (1112/1152), χ²=9.013, P=0.003). As to the supervision and follow-up management, the rates of supervision and follow-up management were both 100.00% in the two groups; while the rate of medical staff participating in supervision and management in the DOTS+WeChat group was significantly higher than that in the single DOTS group (100.00% (836/836) vs. 75.87% (874/1152), χ²=17.330, P<0.001). The complete follow-up rate in consolidation period and the rate of follow-up during the whole course in the single DOTS+WeChat group were significantly lower than those in the DOTS+WeChat group (98.35% (1133/1152) vs. 100.00% (836/836), χ²=13.921, P<0.001; 98.09% (1130/1152) vs. 99.76% (834/836), χ²=11.335, P=0.001). Conclusion The treatment management of DOTS combined with WeChat was better than the single DOTS, it was a feasible and effective management for tuberculosis patient.

Key words: Tuberculosis, pulmonary, Care management, WeChat, Outcome and process assessment (health care)

李源, 高风华, 金锋. DOTS联合微信管理方式对肺结核患者治疗管理效果的评价[J]. 结核与肺部疾病杂志, 2021, 2(1): 50-53. doi: 10.3969/j.issn.2096-8493.2021.01.011

LI Yuan, GAO Feng-hua, JIN Feng. Evaluation of treatment and management effect of DOTS combined with WeChat on pulmonary tuberculosis patients[J]. Journal of Tuberculosis and Lung Disease, 2021, 2(1): 50-53. doi: 10.3969/j.issn.2096-8493.2021.01.011

图/表 1

表1

各临床特征在DOTS+微信组和DOTS组中的分布情况

临床特征	DOTS组(1152例)	DOTS+微信组(836例)	检验值	P值
性别			χ²=0.511	0.475
男	766(66.49)	543(64.95)
女	386(33.51)	293(35.05)
年龄(岁, $x ˉ$ ±s)	45.0±1.3	47.0±2.1	t=0.881	0.318
文化程度			χ²=0.726	0.696
小学及以下	31(2.69)	22(2.63)
初/高中	1039(90.19)	747(89.36)
本科及以上	82(7.12)	67(8.01)
病原学检查结果			χ²=1.367	0.242
阳性	455(39.50)	352(42.11)
阴性	697(60.50)	484(57.89)
患者类型			χ²=0.106	0.745
初治	1140(98.96)	826(98.80)
复治	12(1.04)	10(1.20)

表1

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DOTS联合微信管理方式对肺结核患者治疗管理效果的评价

Evaluation of treatment and management effect of DOTS combined with WeChat on pulmonary tuberculosis patients

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