多重抗藥性結核病患DOTS-PLUS照護模式滿意度調查-以中區為例

Abstract

Purpose: Multi-drug resistant tuberculosis (MDR TB) has been an important global public health issue. The CDC (Centers for Disease Control) of Taiwan has actively pushed forward the DOTS-PLUS (Directly Observed Treatment Short-course Plus) care model to address this issue. The study compared the DOTS-PLUS care with DOTS care to reveal the difference in patient knowledge of disease and to explore factors associated with patient satisfaction of their tuberculosis care service. Methods: This study was a cross-sectional survey. In the CDC registry, patients with MDR TB registered from May 2007 to Dec 2011 who received the DOTS-PLUS care for MDRTB in central Taiwan were assigned into the DOTS-PLUS group. Patients with drug sensitive tuberculosis registered from Jan 2011 to Dec 2011 who received DOTS care from the public health system in central Taiwan were assigned in to the DOTS group. With convenience sampling, the relevant information was collected with a structured questionnaire. Multiple regression analysis was employed to explore factors associated with patient satisfaction of their tuberculosis care service. Results: There were 70 (31.8%) and 150 (68.2%) valid responses in the DOTS-PLUS and DOTS groups, respectively. Regarding patient knowledge of disease, there were lower levels in the two items “Dining utensils should be separated” and “Chinese medicine can treat tuberculosis” in both groups. After controlling for the associated factors, higher knowledge level of disease was found in the DOTS-PLUS group. However, the difference was not statistically significant. Regarding patient satisfaction of their tuberculosis care service, the attention to patient discomfort and disease progression from the care providers was more appreciated in the DOTS-PLUS group. The patients in the DOTS-PLUS group also showed significantly higher level of satisfaction with the attitude of care providers dealing with side effects, flexible home visit schedule, home delivery of injections, the impact of tuberculosis care to daily living, and care effectiveness. The overall satisfaction of the DOTS-PLUS group (87.24±10.48) was significantly higher than that of the DOTS group (77.69±16.56) (p<0.001). Factors associated with overall satisfaction included age, marital status, average monthly family income and job interference due to tuberculosis. Conclusions and Recommendations: Patients with MDR TB who received the DOTS-PLUS care were more satisfied with their tuberculosis care than patients with drug sensitive tuberculosis who received the DOTS care. According to the results of the study, the DOTS-PLUS care for MDR TB in central Taiwan was suggested to: (1) minimize side effects of treatments; (2) enrich the knowledge of tuberculosis of the patients and their families; (3) schedule continuous education for care providers; and (4) integrate social care resources. The CDC was suggested to: (1) improve the patient knowledge of disease; (2) enhance tuberculosis patient care and service through case management systems; and (3) popularize the DOTS-PLUS care model.