臺北市結核病患完成治療之相關因素探討

Factors Influencing the Completion of Anti-tuberculosis Therapy in Taipei

鄒治儉(Jyh-Jeam Tzou) ； 林秀琴(Hsiu-Chin Lin)

《北市醫學雜誌》 4卷4期 (2007/04) Pp. 302-309

https://doi.org/10.6200/TCMJ.2007.4.4.06

摘要

目的：為探討結核病患於不同層級醫院與完成治療之相關因素。方法：研究期間91年1月至12月完成通報之新結核病個案，使用橫斷式研究法(Cross-section study)進行統計分析。結果：(1)以男性、國小、無業等身分居多；(2) 76%以上個案初次就醫選擇醫學中心及區域醫院；(3)治療結果中完成治療佔總數之75%、十二個月未完成治療者以地區醫院佔多數；(4)防癆體系所通報及同醫院同醫師通報銷案者其完治高於未完治；(5)以邏輯斯迴歸分析完成治療，則防癆體系通報完成治療是醫學中心的0.23倍；是其他醫院0.17倍；在通報與銷案醫院一致性，其完成治療為同醫師是不同醫師的0.30倍，總言之在防癆體系或同醫師其完成治療相對比率較高。結論：本研究顯示出防癆體系有其時代存在之義意實不宜廢止，應是進一步加強公共衛生體系與各醫療院所，建立防治結核病網絡以增進個案管理。

關鍵字

結核病患 ； 結核病完成治療結果 ； 醫療院所評鑑層級

並列摘要

The purpose of this study is to evaluate the treatment of tuberculosis (TB) patients and related medical factors influencing treatment outcome at different levels of hospitals in Taipei. This study is a cross-sectional study of all newly reported TB cases between January and December, 2002. The results showed that: 1) Most cases were unemployed males with primary school education; 2) More than 76% of cases were initially diagnosed at medical centers and regional hospitals; 3) Only 75% of all diagnosed cases completed treatment. However, incomplete treatment occurred in community hospital; 4) The rate for diagnoses which were changed to non-TB diagnoses was higher in primary health care organizations than in higher-level hospitals; and 5) The rate of complete treatment was higher in hospitals with TB control programs (where patients were treated by the same doctor throughout the treatment period); and 6) Multiple logistic regression analysis showed the following: odds ratio for hospitals with TB control programs was 0.23 for medical centers and 0.17 for all other hospitals. In conclusion, the rate of completed treatment was higher in hospitals with TB control programs. It was also higher among patients who were treated by the same doctor throughout the treatment period. These results indicate that TB control programs need to be maintained, not abolished. In addition, in order to improve TB case management, coordination and cooperation among all public health organizations need to be improved. It is hoped that the results of this study will provide references for future TB control programming.

並列關鍵字

tuberculosis patients ； treatment outcome ； hospital accreditational levels