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目的调查边远贫困地区肺结核病人DOT管理现状,了解边远贫困地区肺结核病人DOT管理中存在的问题和影响因素。方法随机抽取2个人口在40万以上的国家级贫困县查阅2005年2006年的季报表、年报、病案等归档材料进行汇总、分析,并抽取这2个县距县城10 km以上的12个乡,对2005年登记管理化疗结束的涂阳肺结核病人采用现场问卷方式调查和追访,了解病人DOT管理情况及影响因素,分析评价边远贫困地区肺结核病人DOT管理质量。结果有效的109例涂阳病人中直接面视服药率为19.3%,75.2%的病人为自服药;治愈率为41.3%,完成疗程率为38.5%,18.4%的病人因各种原因为不规则治疗;县、乡、村3级防痨人员由于人力、时间、经济等因素不能做到直接面视规律服药;影响病人服药依从性、疗程期间查痰多为主观因素,并与病人年龄、结核病知识知晓情况、督导管理质量和频次、药物不良反应相关。结论边远贫困地区肺结核病人的DOT管理质量情况不尽人意。探索适合远贫困地区实际情况,切实可行的病人DOT管理方法,是我省边远贫困地区实施DOT策略亟待解决的问题,同时提高病人对结核病防治知晓率是提高病人规律服药的重要措施之一。
Objective To investigate the current situation of DOT management of tuberculosis patients in remote and poverty-stricken areas and to understand the problems and influencing factors in the management of tuberculosis patients in remote and poverty-stricken areas. Methods A total of 2 archived materials with a population of over 400,000 in 2004 were collected and analyzed according to the quarterly reports, annual reports and medical records of 2005-2006. Twelve counties with the county above 10 km , Survey and follow-up of smear-positive pulmonary tuberculosis patients who finished the management of chemotherapy in 2005 were conducted on the spot questionnaire to understand the management of patients’ DOT and its influencing factors, and to analyze and evaluate the quality of DOT management of tuberculosis patients in remote and poverty-stricken areas. Results Among the 109 smear-positive patients, 19.3% of them were treated directly and 75.2% of patients were self-medication. The cure rate was 41.3% and the complete cure rate was 38.5%. 18.4% of the patients were irregular due to various reasons Treatment; county, township, village level 3 anti-痨 personnel because of manpower, time, economy and other factors can not be directly treated as a regular medication; affect patient compliance medication, sputum examination during the subjective factors, and with the patient’s age, tuberculosis Knowledge of the situation, supervision and management of quality and frequency, adverse drug reactions. Conclusion The quality of DOT management of tuberculosis patients in remote and poverty-stricken areas is unsatisfactory. Exploring the DOT management method suitable for the actual situation and feasible patients in remote areas is an urgent problem to be solved in implementing DOT strategy in outlying and poverty-stricken areas in our province. At the same time, it is one of the most important measures to improve patients’ awareness of tuberculosis prevention and treatment.