多明尼加共和国圣多明各药房和街角商店增加结核症状患者转诊干预措施的有效性

The open infectious diseases journal Pub Date : 2013-04-19 DOI:10.2174/1874279301307010047

E. Mitchell, E. Pérez-Then, Ivonne Orejel-Juarez, Jeannette Báez, F. Gonzales, A. Morrobel, B. Marcelino, N. Kamp

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引用次数: 8

摘要

私营部门和社区领导人的参与是改善结核病病例发现的流行战略。然而，让药店和社区店主参与结核病转诊的影响各不相同，实现这一目标的最佳方法尚不清楚。为了评估讲习班和/或动机性“详细”访问后转诊和结核病病例检出率的变化，神秘客户访问了188家药店和103家杂货店，就反映肺结核的慢性症状寻求建议。大多数站点(89% n=255)暴露于“细节”，26.8%(76)还参加了由国家结核病规划和KNCV结核病基金会(KNCV)设计的1小时讲习班。在干预前和干预后对站点进行评分，在以下方面各得1分:a)自发识别结核病症状;b)在提示时识别可能是结核病的症状;c)转诊到医疗机构;d)不推广药物;e)现场展示结核病健康教育材料;f)将神秘客户转诊到结核病项目。所有暴露机构的结核病识别和转诊分数平均提高了2.0分(95% ci)。1.9- 2.1)，相比之下增加了0.6点(95% c.i.。0.4 ~ 0.0.9)，差异有统计学意义(p<0.001)。抗生素和姑息药的尝试销售从基线时的38.3%下降到16.1%。六个月后，33.1%的药店和22.7%的杂货店报告了参考。在药店转诊的70名结核病嫌疑人中诊断出7例痰检阳性结核病病例，但在杂货店送来的30名嫌疑人中没有诊断出一例。该地区的结核病调查在六个月期间上升了8.4%。这一干预措施很可能使两年来结核病例通报数翻了一番。一个简单的动机干预导致转诊和结核病病例发现的改善。国家结核病规划向其他省份引入了与药店合作的干预措施。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Effectiveness of Interventions to Increase Referral of Clients ExhibitingTB Symptoms by Pharmacies and Corner Stores in Santo Domingo,Dominican Republic

Engagement of the private sector and community leaders are popular strategies for improving tuberculosis (TB) case detection. However the impact of engaging pharmacies and community shop keepers in TB referral varies and the best method to achieve it are unknown. To evaluate changes in referral and TB case detection following workshops and/or motivational "detailing" visits, mystery clients visited 188 pharmacies and 103 grocery stores to seek advice for chronic symptoms reflecting pulmonary TB. Most sites (89% n=255) were exposed to "detailing" and 26.8% (76) also attended 1 hour workshops designed by the National TB program and KNCV Tuberculosis Foundation (KNCV). Sites were scored pre- and post-intervention, obtaining 1 point each for a) spontaneous recognition of TB symptoms, b) acknowledgement of symptoms as possibly TB when prompted, c) referral to medical care d) not promoting drugs e) exhibiting TB health education materials on site and f) referral of mystery clients to the TB program. The TB recognition and referral scores of all exposed establishments increased by an average of 2.0 points (95%C.I. 1.9- 2.1) at post-test compared with an increase of 0.6 points (95%C.I. 0.4-.0.9) among those in the comparison group (p<0.001). Attempted sales of antibiotics and palliatives declined from 38.3% at baseline to 16.1%. After six months, 33.1% of pharmacies and 22.7% of grocery stores reported referring. Seven smear-positive TB cases were diagnosed from among 70 TB suspects referred by pharmacies, but none from among 30 suspects sent by groceries. TB investigations rose by 8.4% in the area for a six month period. The intervention is likely to have contributed to the doubling of TB case notifications over two years. A simple motivation intervention led to improvement in referral and TB case detection. The National TB program introduced interventions with pharmacies to other provinces.

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The open infectious diseases journal

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