| BackgroundDrug-resistant tuberculosis(DR-TB)is highly infectious and has a low cure rate,which seriously threatens public health.However,due to its long course and high cost,medication adherence of patients is generally low,which is an important factor affecting therapeutic outcome.At present,there are many researches on medication adherence and influencing factors in patients with common tuberculosis,while DR-TB is relatively rare.Moreover,most studies only focus on single influencing factors,lacking systematic and comprehensive analysis.ObjectiveThe purpose of this study is to understand the medication adherence and its influencing factors of DR-TB patients during the entire process management,to identify existing problems and reasons,and to explore the interaction of factors such as information,motivation,and behavioral skills and their impact on medication adherence based on IMB theory.To provide a scientific basis to improve the management and adherence of DR-TB patients in China.MethodsNine cities in Shandong and Zhejiang province were used as survey sites to collect research data through questionnaires and key informant interview.The questionnaire surveys acquire the patient's basic situation,the management services and medication adherence.Key informant interview acquire the implementation of management,difficulties and suggestions for improving patients adherence.General statistical descriptive indicators such as mean,standard deviation and median were used to describe and analyze the scores of demographic characteristics,information,motivation and behavioral skills scales.Logistic regression analysis was used to evaluate the impact of management and patients basic conditions on information,motivation,and behavioral skills,and to evaluate the influencing factors of patients medication adherence.Data analysis is mainly completed by Exce12010 and SPSS 21.0 software.Results(1)Medication adherence:Among the 276 respondents,85(30.8%)of them failed to take medicine on time,and most of them failed to take medicine for less than 5 times(67.0%).Thirty-three patients were discontinued for two weeks or more,accounting for 11.8%.Among the patients who discontinued medication,more patients were discontinued due to drug side-effect,accounting for 48.5%.(2)Administrative situation:The completion of the monitoring drug side-effect and health education in Shandong Province is significantly higher than in Zhejiang Province.Among the community management,patients in Shandong received more supervision(51.4%),which was significantly higher than that in Zhejiang(21.5%).In Zhejiang province,more patients were followed up by community doctors(89.0%).(3)Information,motivation,behavioral skills scale scores:The average score of information was 3.57± 1.17.The motivation was divided into positive and reverse questionnaires,with an average score of 4.00± 1.04 in the positive questionnaires and 3.40±1.26 in the reverse questionnaires.The average score of behavioral skills was 3.96±1.17.The above scales all scored higher in Shandong Province.(4)Analysis of influencing factors:The results of multi-factor analysis showed that information,motivation,behavioral skills were affected by a variety of factors,among which information and motivation would directly affect behavioral skills.Motivation,behavioral skills and follow-up management were the main factors affecting patients'medication adherence.Conclusion and suggestionsThe current medication adherence of patients is low.The main reason is that there are many problems and deficiencies in the management.And there are great differences in the management models of Shandong and Zhejiang Province.Patients' poor knowledge and insufficient information acquisition affect their motivation and self-discipline.Therefore,the area with fewer patients can adopt the model of designated hospital treatment and management.However,for areas with more patients,it is recommended to establish a comprehensive community-based management network. |
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