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文摘发布】 在医疗资源匮乏地区提高结核病人持
Author: Thiam S, LeFevre AM, Hane F, Ndiaye A, Ba F, Fielding KL, Ndir M, Lienhardt C.
Resourse: JAMA. 2007 Jan 24;297(4):380-6.
CONTEXT: Poor adherence to treatment remains a major obstacle to efficient tuberculosis control in developing countries. Innovative strategies to improve access and adherence to treatment are needed. OBJECTIVES: To assess the effectiveness of a contextualized intervention strategy aimed at improving patients' adherence to treatment and to evaluate its impact on TB control in a resource-poor country in Africa with prevalent TB infection. DESIGN, SETTING, AND PATIENTS: A cluster randomized controlled trial, conducted between June 2003 and January 2005, at 16 government district health centers in Senegal. Patients older than 15 years with newly diagnosed sputum smear-positive pulmonary TB were randomly assigned to the intervention or control group. INTERVENTION: The intervention strategy included reinforced counseling through improved communication between health personnel and patients, decentralization of treatment, choice of directly observed therapy (DOT) supporter by the patient, and reinforcement of supervision activities. In the control group, the usual TB control program procedures remained unchanged. MAIN OUTCOME MEASURE: Proportion of patients successfully completing the 8-month course of treatment and the proportion of patients defaulting from treatment. RESULTS: A total of 1522 patients were recruited into the study. Treatment was successful for 682 (88%) of 778 patients recruited in the intervention group, and for 563 (76%) of 744 patients recruited in the control group (adjusted risk ratio [RR], 1.18; 95% confidence interval [CI], 1.03-1.34). The proportion of patients defaulting was reduced in the intervention group to 5.5% (n = 43) compared with 16.8% (n = 125) in the control group (adjusted RR, 0.43; 95% CI, 0.21-0.89). CONCLUSION: The intervention package based on improved patients counseling and communication, decentralization of treatment, patient choice of DOT supporter, and reinforcement of supervision activities led to improvement in patient outcomes compared with the usual TB control procedures. This approach may be generalized in the context of TB control programs in resource-poor countries. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00412009.
PMID: 17244834 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领。 Title: Effectiveness of a strategy to improve adherence to tuberculosis treatment in a resource-poor setting: a cluster randomized controlled trial.
题目：在医疗资源匮乏地区提高结核病人持续治疗率政策的效果：一项随机对照研究
作者: Thiam S, LeFevre AM, Hane F, Ndiaye A, Ba F, Fielding KL, Ndir M, Lienhardt C.
Resourse: JAMA. 2007 Jan 24;297(4):380-6.
来源：美国医学协会杂志，2007年1月24日
CONTEXT: Poor adherence to treatment remains a major obstacle to efficient tuberculosis
背景：治疗缺乏连续性一直是结核治疗效率的一个主要障碍
这儿不怎么通顺，是不是中间落下了一部分？(T control in developing countries. 请按照文摘类新闻投稿格式编译。 一项随机对照研究研究了在医疗资源匮乏地区提高结核病人持续治疗率政策的效果
Thiam S, LeFevre AM, Hane F等进行了一项随机对照研究评价了在结核病流行的非洲医疗资源匮乏地区提高病人治疗连续性的干预政策的效果（美国医学协会杂志，2007年1月24日）
该项研究是在2003年6至2005年1月的时间内在塞内加尔16个政府的社区卫生院内进行的，病人来源为年龄超过15岁的最新诊断为痰涂片阳性的肺结核病病人，研究者把他们随机指定给干预组和对照组，然后检测成功完成8个月治疗疗程的病人比例和缺省治疗病人的比例。结果显示1522个病人全部恢复到学习中，在干预组778个恢复的人中有682人（88%）治疗成功，在对照组744个恢复的人中有563人（76%）治疗成功（校正危险比率1.18；置信区间95%：1.03-1.34）。同对照组16.8%（n=25）的比率相比，干预组缺省治疗病人的比率下降到5.5%（n=43）（校正危险比率0.43%，95%置信区间：0.21-0.89）。
干预策略包括通过提高卫生人员和病人的交流来强化咨询，分散治疗，病人直接观察治疗支持者的选择，及监督力度的加强，该项策略导致同常规结核控制操作相比病人治疗效果的改善。因此在医疗资源缺乏的国家的结核控制过程中这策略可能被推广。
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作者:admin@医学,生命科学 2010-10-17 17:11
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