結核発生動向調査結果を用いた地域DOTSの効果の評価 EVALUATION OF EFFECT OF COMMUNITY DOTS ON TREATMENT OUTCOMES BY TB SURVEILLANCE DATA

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〔目的〕地域DOTSの治療成績への効果を評価し,課題を検討する。〔対象〕2003年と1998年に登録された喀痰塗抹陽性初回治療患者で標準治療を受けた者。〔方法〕結核の治療成績を,地域DOTS実施前後で比較した。また,生活保護対象者の死亡予防可能性を検討した。〔結果〕外来DOTSを実施した保健所では,社会.国民保険加入者の治療成功率や脱落率の改善を認め,老人保健加入者の脱落率の改善が示唆され,生活保護対象者の脱落率が半減して治療成功率は改善傾向を示した。訪問DOTSを実施した保健所では,国民保険加入者と老人保健加入者の脱落率の改善が示唆された。連絡確認DOTSのみの保健所では,情報把握が不十分だった。生活保護対象者の死亡率は,受給中の者に比して申請中の者で高く,健診発見例に死亡例が少ない傾向があった。〔考察・結論〕外来DOTSと訪問DOTSは治療結果の改善を示した。しかし,連絡確認DOTSのみの保健所は,情報把握が課題である。また,高齢者の高死亡率が未解決である。生活保護対象者の死亡予防策として,ハイリスク者健診の強化,有症状時の早期の医療機関受診の促進,生活保護捕捉率の向上が考えられた。

[Objective] The purpose of this study is to evaluate effects of community DOTS on treatment outcome by cohort data derived from TB surveillance system and to find further problems.<BR>[Sub jects] New sputum smear positive pulmonary TB patients registered in 2003 and 1998 under standard course regimens.<BR>[Methods] In Japan, DOTS as a method of directly observed treatment by Short Course Chemotherapy is divided into hospital DOTS and community DOTS. Hospital DOTS is to observe hospitalized patients' drug taking directly by hospital staff such as nurses, pharmacists or other hospital staff. Community DOTS is to observe or confirm discharged patients' drug taking by several methods such as direct observation at facility or patient's home, confirmation through checking treatment notes and examining empty blister packages and so on. TB patients were categorized to following 3 groups by available methods of community DOTS. Treatment outcome of patients registered in 2003 was compared with outcome of patients registered in 1998 as the control group before the introduction of community DOTS.<BR>Group 1: TB patients under PHC whe re at least daily observation DOTS (daily observation of drug taking at clinic or PHC to TB patients with risk factors of defaulting such as homeless, alcohol abuse, past history of default and so on) is available.<BR>Group 2: TB patients under PHC where home-visit DOTS (home-visit for observation of drug taking to the elderly TB patients who have risk to forget to take TB medicines regularly) only is available or, PHC where home-visit DOTS and confirmation DOTS (periodical confirmation of drug taking to TB patients without risk of defaulting) is available.<BR>Group 3: TB patients under PHC where only co nfirmation DOTS is available.<BR>Group 4: TB patients under PHC where community DOTS is not available.<BR>In addition, high death rate of patients under public assistance is analyzed.<BR>[Results] In group 1 with daily observation DOTS, TB patients under social or national health insurance showed higher treatment success rate and lower defaulter rate. TB patients with insurance for aged showed lower defaulter rate but high death rate due to old age did not improve. Patients under public assistance showed relatively lower defaulter rate. In group 2 with home-visit DOTS, TB patients with national health insurance and insurance for aged showed rather lower defaulter rate. Cohort evaluation of TB patients under group 3 with confirmation DOTS and group 4 without community DOTS is difficult as high rate of unknown treatment result.<BR>TB patients receiving public assistance showed lo wer death rate than patients requiring but not receiving public assistance. Patients detected at clinic and hospitals showed higher death rate than other patients detected by screening for high risk groups and so on.<BR>[Conclusion ] Daily observation DOTS and home-visit DOTS were effective to improve success rate and defaulter rate but effect of confirmation DOTS was not proved due to lack of information. High death rate of patients with insurance for aged in all groups and lack of treatment results in group 3 and 4 were problems to be solved in the future. In order to avoid TB death among TB patients under public assistance, screening for homeless people as high risk groups, earlier detection and referral system of TB symptomatics and improvement of coverage in public assistance might be effective and be tried.

収録刊行物

  • 結核  

    結核 81(10), 591-602, 2006-10-15 

    JAPANESE SOCIETY FOR TUBERCULOSIS

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各種コード

  • NII論文ID(NAID)
    10018812721
  • NII書誌ID(NCID)
    AN00073442
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    00229776
  • NDL 記事登録ID
    8544313
  • NDL 雑誌分類
    ZS21(科学技術--医学--内科学)
  • NDL 請求記号
    Z19-133
  • データ提供元
    CJP書誌  CJP引用  NDL  J-STAGE 
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