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背景:对纽约市立医院的结核病人实施直接观察治疗(DOT)规程。材料:主动前瞻性发现住院的结核病人,并实施特殊的直接观察治疗(DOT)规程模式。判断病人自愿接受DOT和其坚持治疗有关的因素。方法:对每天自愿接受DOT的住院病人监督。对选择DOT的病人提供具体的服务和激励措施。门诊诊室作为当地的直接观察治疗点。当病人有1次或以上遗漏DOT次数时,给予必要措施。结果:本研究期间,对176例中的95％接受DOT的住院结核病人进行评估。其中137例符合入选DOT条件,85％选择接受DOT(95％可信度[CI]为77.5～90％)。违禁药使用与较高可能接受DOT无关(优势比OR,4.88;95％可信度〔CI〕,1.5～15.7)。101例接受DOT的病人中,使用违禁药(OR,0.21;95％CI,0.08～0.6)和以前结核治疗过(OR,0.27;95％CI,0.27～0.7)两者与低接受治疗无关。然后,由于加强了病例管理,队列分析中仅有1％的病人随访丢失,总治疗完成指数达到98％。结论:对住院病人监测是接受DOT高效策略。DOT模式提供招致病人参加出院安排,提供激励措施能使病人自愿接受DOT率提高。对门诊病人的管理,特别是那些不继续治疗的病人是完成治疗率的高效方法。
Background: Direct observation and treatment (DOT) procedures are performed on TB patients in New York City Hospital. MATERIALS: Proactively identify hospitalized TB patients and implement specific DOT procedures. Determine the patient willing to accept the DOT and its adherence to treatment-related factors. Methods: Inpatient supervision of patients who volunteered to receive DOT daily. Provide specific services and incentives to patients who choose DOT. Outpatient clinics serve as local direct observation points. When the patient has 1 or more missed DOT times, given the necessary measures. Results: During the study, 95% of 176 hospitalized tuberculosis patients undergoing DOT were evaluated. Of these, 137 were eligible for DOT and 85% were DOT (95% confidence [CI] 77.5 to 90%). Illegal drug use was not associated with a higher likelihood of receiving DOT (odds ratio OR, 4.88; 95% CI [CI], 1.5-15.7). Of the 101 DOT-treated patients, the use of illegal drugs (OR, 0.21; 95% CI, 0.08-0.6) and previous TB treatment (OR, 0.27; 95% CI, 0.27-0.7) were not associated with lower treatment. Then, due to enhanced case management, only 1% of patients in the cohort were followed-up lost, with a total treatment completion index of 98%. Conclusion: Inpatient monitoring is a DOT efficient strategy. The DOT model provides incentives for patients to participate in discharge arrangements and provides incentives for patients to voluntarily accept DOT rates. The management of outpatients, especially those who do not continue to treatment is an efficient way to complete the treatment rate.