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目的了解深圳市南山区抗结核固定剂量复合制剂(FDC)药物服药情况,从而改进对肺结核患者的督导管理。方法从电子服药系统中导出2013年10月1日至2014年9月30日南山区管理的363例肺结核患者的服药数据,用Excel 2007软件建立数据库进行数据整理、分类筛选统计,采用描述性统计方法分析数据。将研究对象按督导方式分为全程督导组及强化期督导组,以督导点不同将研究对象划分为一级督导点组及三级督导点组,以应用电子系统管理时间将患者分为应用前组(n=437)及应用后组(n=363),利用SPSS 13.0软件对构成比或率进行χ2检验。结果首选FDC药物占总管理患者数的82.65%(300/363),其中,首选且全程服用FDC药物占53.99%(196/363),全程督导组中首选全程服用FDC药物的患者比例为48.69%(112/230),强化期督导组中比例为63.16%(84/133),两组间差异有统计学意义(χ2=7.096,P<0.05);首选FDC药物中途换药的占28.66%(104/363),换药原因中药物不良反应占换药比例77.88%(81/104);全程服用FDC药物带药患者比例为47.96%(94/196),其中全程督导组带药患者的比例为67.86%(76/112),强化期督导组带药患者的比例为21.43%(18/84),两组间差异有统计学意义(χ2=41.457,P<0.05)。2013年10月1日至2014年9月30日,三级督导点组该时段服药总天数占一级与三级督导点组该时段患者总服药天数比例为32.66%(20 523/62 836),一级督导点组患者服药总天数所占比例为67.34%(42 313/62 836),差异有统计学意义(χ2=3 747.59,P<0.05);在该时段,三级督导点组累计月管理服药患者数占一级与三级督导点组总累计月管理服药患者数比例为40.15%(931/2 319),一级督导点组累计月管理服药所占比例为59.85%(1 388/2 319),差异有统计学意义(χ2=105.87,P<0.05);应用电子服药系统前后患者治愈率或完成治疗率分别为90.10%、91.46%,差异无统计学意义(χ2=0.399,P>0.05)。结论电子服药系统不但方便了肺结核患者取药,还有利于医务人员对南山区的督导服药情况进行详尽了解,为进一步加强和改进督导管理工作奠定了基础。
Objective To understand the medication of anti-tuberculosis fixed-dose combination (FDC) drugs in Nanshan District of Shenzhen City so as to improve the supervision and management of tuberculosis patients. Methods The data of 363 tuberculosis patients administrated in Nanshan District from October 1, 2013 to September 30, 2014 were derived from the electronic drug delivery system. The database was set up with Excel 2007 software for data sorting, classification and screening statistics, descriptive statistics Method to analyze the data. The research object is divided into the whole supervision group and the supervisory group according to the supervising method. According to the supervising points, the research object is divided into the first class and the third class, and the application time is divided into before application Group (n = 437) and post-application group (n = 363) .χ2 test was performed on constituent ratio or rate using SPSS 13.0 software. Results The first choice of FDC drugs accounted for 82.65% (300/363) of the total number of patients under management, of which, the first choice and the whole course of taking FDC drugs accounted for 53.99% (196/363), the first time in the whole supervision group the first choice of taking FDC drugs in the proportion of patients was 48.69% (112/230) in intensive care group, 63.16% (84/133) in intensive care group, with significant difference between the two groups (χ2 = 7.096, P <0.05) 104/363). The proportion of adverse drug reactions in drug-changing patients was 77.88% (81/104). The proportion of patients who took FDC drugs in the whole process was 47.96% (94/196) , Which was 67.86% (76/112). The proportion of patients in intensive supervision group was 21.43% (18/84). The difference between the two groups was statistically significant (χ2 = 41.457, P <0.05). From October 1, 2013 to September 30, 2014, the total number of days of taking medication in the three-level steering group during this period was 32.66% (20 523/62 836) , The total number of days in the first-level supervising point group was 67.34% (42 313/62 836), the difference was statistically significant (χ2 = 3 747.59, P <0.05). During this period, The monthly cumulative number of patients receiving medication administration accounted for 40.15% (931/2 319) of the total monthly cumulative number of patients administered medication in the first-grade and third-grade supervisory groups, and the proportion of cumulative monthly medication administration in the first-class group was 59.85% (1 388 / 2 319), the difference was statistically significant (χ2 = 105.87, P <0.05). The cure rate or completed treatment rate before and after application of the electronic medication system was 90.10% and 91.46%, respectively, with no significant difference (χ2 = 0.399, P> 0.05). Conclusion The electronic medication system not only facilitates the taking of medicines for patients with pulmonary tuberculosis, but also helps the medical staff to make a detailed understanding of the supervision and administration of medication in Nanshan District, which lays the foundation for further strengthening and improving supervision and management.