目標：結核病是全球重要的健康問題之一，未完成治療不但是影響國內結核病防治的重大因素，同時也增加防疫與治療上的困難，因此本研究希望藉由全國性之調查，了解造成肺結核患者未完成治療之因素。方法：本研究對象爲疾病管制局2001年1~12月所登錄全國之肺結核病急，針對完治及未完治病患，利用分層隨機比例抽樣，以電話訪問方式進行問卷調查。並利用羅吉斯迴歸分析探討影響肺結核患者是否完成肺結核治療之相關因素。結果：在治療的過程中以服藥後有副作用(30.7%)及感覺很不舒服(25.8%)爲困擾及造成肺結核病患未完治之主要問題。曾因爲罹患肺結核而更換工作或離職者其未完治機率較低（勝算比0.46)；病患治療過程中曾中斷服藥者其未完治機率顯著較高（勝算比4.37）。另外，治療期間有更換過醫院、中等教育程度、家庭收入低、未規則服藥。治療過程對生活相當有影響者亦有較高的機率未完成治療。然病患越瞭解服用藥物後的副作用越有未完成治療的傾向，當病患瞭解肺結核傳染途徑及治療時間時則其未完治機率較低。結論：由本研究結果可知藥物副作用、服藥遵從性、對肺結核疾病的認知及是否有固定就醫場所都是影響肺結核病患是否完治的重要關鍵因素。因此，需加強病患對疾病與療程的認知，同時醫療院所實施個案管理是降低肺結核病患未完治率的首要任務。
Objectives: Incomplete treatment is an important factor, which contributes to the difficulty in the prevention and treatment of tuberculosis (TB). This study investigated the factors associated with treatment failure in TB patients. Methods: The data were derived from the Center for Disease Control (CDC) nationwide dataset of pulmonary TB patients registered in 2001. TB patients were selected by proportional random sampling. Structured questionnaires were used to interview TB patients by phone, and logistic regression analysis was used to examine the factors that affected treatment outcome. Results: TB patients reported that side effects (30.7%) and general discomfort (25.8%) were the main problems encountered after taking medication. Treatment failure rates were lower in patients who changed jobs during treatment (OR 0.46) and higher in patients who interrupted treatment (OR 4.37). Other factors contributing to treatment failure included changing hospitals during treatment, having a mid-level education, having lower household income, taking medication irregularly, and the negative effect TB has on quality of life. In addition, patients who knew about the drugs' side effects had higher treatment failure rates; furthermore, patients who had knowledge about the transmission route of TB and the time needed for successful treatment had lower rates of treatment failure. Conclusion: Side effects of medication, compliance, the awareness of TB, and regular place of care were the key factors for successful TB treatment. Based on the results, we conclude that patients need to be made aware of TB and the appropriate treatment courses. The implementation of a case management program may increase the rate of successful treatment.
關聯:
台灣公共衛生雜誌 24(4)348~359 Taiwan Journal of Public Health 24(4 )348 ~359
