【摘要】 目的:编制肺结核患者治疗依从性的评分系统。方法:采用现况调查研究对124名肺结核患者的治疗依从性及其影响因素进行调查,用Logistic回归模型筛选影响依从性的预测指标,根据模型参数对预测指标的取值进行量化评分,编制出治疗依从评分系统(adherence rating score,ARS),然后选择574例肺结核病例在治疗开始前按ARS评分划分为依从组(247例)与不依从组(327例),再将不依从组随机分为干预组(146例)和对照组(181例)两个亚组;干预组的干预措施是基于ARS的定制宣教资料,对照组为常规的结核病宣传资料。比较各组疗程第6个月的累积不依从率。结果:编制出的ARS共7个条目,内容涵盖结核病的知识、态度和行为(KAP),以及患者的生活习惯与社会支持等多个维度;依从者和不依从者的ARS评分(均数±标准差)分别为:2.38±0.18和4.69±0.20,两者差异有统计学意义(t=8.52,P<0.01)。在随机对照试验中,干预组和对照组6个月的累积不依从率分别为:24.7%和41.4%,两者差异有统计学意义(P<0.01);而干预组和依从组6个月的累积不依从率差异无统计学意义(P>0.05)。结论:ARS评分系统具有较好的效度和信度,可以用于肺结核患者治疗依从性的测评。更多还原

【Abstract】 Objective:To develop an adherence rating score(ARS)system specific for tuberculosis(TB)patients.Methods:A cross-sectional survey of 124 TB patients was conducted to figure out risk factors for adherence to treatment.The step-wise logistic regression models were used for selecting adherence-related variables.ARS was developed based on the weighting scores of the parameters of all the predicted variables in the logistic model.The reliability and responsibility of ARS was evaluated by using external data from an open label randomized controlled trial on 574 TB patients.The patients were grouped as adherence group(247 patients)and non-adherence group(327 patients)based on the predicted ARS.And the non-adherence group was randomized divided into a trail group(146 patients)and a control group(181 patients).The intervention for the trail group was custom health educational material aimed to reduce ARS,while the intervention for control groups was general TB education material,which was routinely used in the current local TB control settings.The cumulative non-adherence rates of the three groups were compared with each other after six-month follow-up period of treatment.Results:The ARS system had 7 items which covered the following domains:disease status,psychology,patients’ KAP(knowledge,attitude,and practice),regularly life-style and social supports.The score of ARS was 2.38±0.18(mean±SD)for adherence patients,and 4.69±0.20(mean±SD)for non-adherence patients(t=8.52,P<0.01).In the randomized controlled trial,the six months cumulative non-adherence rates ware 24.7% for the trail group and it was 41.4% for the control group(P<0.01);while the six months cumulative non-adherence rates were not statistical significant difference between trail group and adherence group(P>0.05).Conclusion:The ARS system was reliability and validity for evaluating the adherence of TB treatment in the stop TB settings in China.更多还原