The Study On Management Situation Of Multidrug-resistant Tuberculosis Patients

Multidrug-resistant tuberculosis (MDR-TB) is cased by bacteria that are resistant to at least isoniazid (INH) and rifampicin (RFP), which with longer duration of treatment, higher expensive, stronger infectivity and the cure rates fall. Currently, problems such as floating populations, multi-drugs resistance tuberculosis, tubercule bacilus and Human immunodeficiency virus mixed infection are the three challenges to tuberculosis control. MDR-TB patients have reached 50 million from the fourth tuberculosis epidemiology investigate in China. About 10 million MDR-TB cases are emerging in China annually according to Multidrug and extensively drug-resistant TB (M/XDR-TB):2010 GLOBAL REPORT ON SURVEILLANCE AND RESPONSE. China has been listed as "specially cause warning countries and regions". MDR-TB outbreak is quite rigorous. In this case, management work of MDR-TB patients is particularly important. Although we has made remarkable successes in TB control and reach the stage of the global TB control targets. However, we has not establish appropriate prevention technology and management model in the country level yet target the MDR-TB control until now. On MDR-TB patients management, government's management policy, preventing institutions' management methods are groping, has a lot of problems. Therefore, establish the management of MDR-TB model that suitable for the situation of China as soon as possible is imperative.Study ObjectiveThe objective of this research is to analyze the management services of MDR-TB patients in treatment process in China, find out lack and related factor of management, in order to provide basic information for establishing a standardized management system and proposing scientific policy and suggestions for establishing one MDR-TB management model which suited to China. Study MethodologyThis study selected Huhehaote city of Neinenggu province, Kaifeng city of Henan province, Lianyungang city of Jiangsu province as the project cities based on the MDR-TB baseline survey data, tuberculosis control levels, geographic distribution and socio-economic conditions. We choose the tuberculosis specialist hospitals in every project city as our research site, and investigate the MDR-TB patients and general patients who were treated in the tuberculosis specialist hospital. Finally, we investigated 44 MDR-TB patients and 100 general patients in all. Also, we investigated the MDR-TB patients'medical record in the tuberculosis specialist hospital 22 copies. In addition, the study also interviewed the key figure of the Municipal Health Bureau, the TB control departments and the municipal specialist hospitals, finally, we interviewed 16 people in all and investigated special hospitals for the basic situation.Both quantitative and qualitative analysis methods were used in the study:Using SPSS 16.0, Excel 2007 software to analyze the quantitative information, mostly make use of descriptive statistics analysis; using Weft QDA software to analyze the qualitative information.Study Results1) Find management of MDR-TB patientsMost medical institution do better in MDR-TB patients referral, but some big hospitals did not good because of the economic interests. Three special hospitals proceed drug sensitive test through the traditional improved roche training. Drug sensitive test results came in with a long cycle and with higher toll, so patients are influenced of timely diagnosis and treatment2) Register reports management of MDR-TB patientsAt present MDR-TB patients register reports management regulations is refer to management methods of patients with drug sensitivity. Information of MDR-TB patients are responsible management by specialist of specialist hospital. But information transfer occurred serious fault between special hospitals and TB institutions from the sample results, and more than 30% patients have lost contact.3) Treatment management of MDR-TB patientsSecond-line drugs equipped of special hospital did not coincide with the provisions of WHO. According to the site collected 22 copies diagnosis medical record, the result indicates that the proportion of MDR-TB patients who receive second-line drugs standard treatment is just 32.3%. During the MDR-TB patients, there are 88.6% patients in hospitals after the first treatment in this specialized hospital, the rest of patients were no referral to TB institutions continue to treatment. After diagnosis,23 patients did not receive directly observed therapy; 12 patients did not receive visiting.Suggestions1) Set up for a series of sustainable management policy measures of MDR-TB.2) Introduction of the rapid and effective diagnosis technology improve MDR-TB patients found rate.3) Perfect the registration reports management mechanism of MDR-TB, especially to establish the transmission mechanism of patients treated information between specialized hospitals with TB institutions.4) Establish diagnosis standard of MDR-TB. Strengthen the training of medical staff, to improve MDR-TB patients hospitalized normative5) Establish observed therapy system including trained professional, improve patients treatment compliance, offer effective economic incentive to the persons who participate in drug supervision.