Study On The Feasibility Of A Remedial Action Management System To Improve TB Patients' Adherence In Chongqing

Background China is one of the 22 countries with heavy TB burden in the world. China was ranked the No.1 to be alerted in the global conference on stop TB in 2004. How to make TB patients finish anti-TB treatment regularly after finding out TB patients is till the importance in current TB control task.Although DOTs recommended by WHO successfully increases cure rate of TB patients in some places, there are till some factors influencing patiients'adherence to anti-TB treatment. So, it is necceray for us to explore a TB management system to improve TB patients'adherence to anti-TB treatment comparing with current TB management.Objectives basing on the current TB patients'management , to set up a proper and promptly remedial action management system to improve TB patients'adherence to complete anti-TB treatment; to evaluate the extent to which the intervention measures were implemented as planned and the implemented feasibility in the study areas. Methods two counties (RC and NC) of different socioeconomic development in Chongqing Municipality were selected to implement pilot intervention. Both qualitative and quantitative studies were conducted. Qualitative study was conducted with open-ended guidelines, whose data were collected from in-depth interview and focus group discussion to 12 patients and 11 TB dispensary staff. All tape records were transcribed and typed into computer. The software of MAXqda was adopted to manage , code and retrieve data. Quantitative date was collected via two newly designed forms– drug collection registration form and remedial action form. 223 new cases and 19 retreated cases in RC, 211 new cases and 19 retreated cases in NC were enrolled into analysis. The software of SPSS 10.0 was used.Results1)Benefits: through one year remedial action management system implemented in pilot areas, patients'completed rate there improved. Especially after remedial management, 90.6% (202/232) of new TB patients and 89.5% (17/19) of retreated patients in RC County completed their course of treatment. 73.9% (156/211) of new patients and 57.9% (11/19) of retreated patients completed their treatment in NC County. In addition, patients'knowledge about TB and their adherence to anti-TB treatment were raised, and the doctor-patient relationship was improved by more interaction. The accountability and cooperation among TB staff were also improved. 2)Problems and Difficulties: difficulties from health provider: work burden of TB staff increased. Sometimes the TB staff have to overwork; parts of patients'real telephone numbers were inaccessible; failed to call the patients because they were at work; misunderstanding of the patients. Difficulties from patients: expensive medical cost and hard traffic condition in mountainous region.3)Feasibility: through the evaluation, we found that this remedial action effectively increased patients'adherence to anti-TB treatment and improved modern TB control. Both TB patients and TB dispensary staff were satisfied with the intervention. Patients welcomed the phone call, which they thought was a sign of good performance and responsibility of a doctor. County TB dispensary staff were happy with the new protocol, which they thought helped them solved the problem of case management and willing to continue it in the future.Conclusion this research provides important lessons on the feasibility of implementing defaulter action based on improved information system at two county TB dispensaries in China. And the finding indicates that the defaulter action intervention will potentially improve the completion rate in the areas where economy, geographical environment and management are poor. If further adjustments could be made, the intervention could be rolled-out in county areas and make great contribution to Chongqing TB control, such as making good use of three-tie TB control network, setting up close cooperation among TB staff and supplying incentive payments to TB staff.Suggestion properly decrease medical cost of TB patients; perfect three-tie TB control network; improve management ability of TB staff; enhance health education force of TB knowledge; better intervention measures.