目標：多重抗藥性結核病是全球重大的公共衛生議題，疾病管制局積極推動針對多重抗藥性結核病患DOTS-PLUS照護，本研究希望了解DOTS-PLUS照護模式相對於一般DOTS照護模式，個案在疾病認知度和滿意度上的差異，及影響服務滿意度的相關因素。
方法：採橫斷式研究，介入組研究對象為疾病管制局2007年5月至2011年12月所登錄多重抗藥性結核病患且接受中區多重抗藥性結核病醫療照護體系DOTS-PLUS照護者(DOTS-PLUS組)；對照組研究對象為疾病管制局2011年1~12月所登錄肺結核病患且接受過中區三縣市公衛體系DOTS照護者(DOTS組)，利用便利取樣以結構式問卷方式進行調查。並利用複迴歸分析探討影響服務滿意度的相關因素。
結果：回收的有效問卷中DOTS-PLUS組有70份(31.8%)，DOTS組有150份(68.2%)。在疾病認知度調查中，針對「用餐需餐具隔離」及「中藥可以治療結核病」二題二組的認知度皆偏低，在控制相關變項後，DOTS-PLUS組在疾病認知度較DOTS組有較高傾向，但無達到顯著差異。在照護感受方面，針對關懷員對病患身體不適與變化之關心、副作用處理態度、關懷員配合訪視時間、到府施打針劑、都治治療對生活之影響、及照護成效滿意度方面DOTS-PLUS組皆顯著高於DOTS組。在整體滿意度方面DOTS-PLUS組(87.24±10.48)亦顯著高於DOTS組(77.69±16.56) (P<0.001)。影響整體滿意度之顯著因素包含年齡、婚姻狀況、家庭平均月收入及是否因病離職或換工作。
結論與建議：整體而言，接受DOTS-PLUS照護病患相較於一般結核病患有較高的照護滿意度。因此本研究建議中區多重抗藥性結核病照護團隊：(1)降低病患藥物後的副作用；(2)增加結核病患與家屬對結核病的認知；(3)照護人員定期接受在職教育訓練；(4) 引進相關社會照護資源。對疾病管制局的建議：(1)加強病患的疾病認知度；(2)加強個案管理單位提高對結核病患的關懷與照護；(3)DOTS-PLUS照護經驗與模式的推廣
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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.
