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原住民肺結核病患未完成治療原因探討
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| 作者 |
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陳照惠 |
| 學校系所 |
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中國醫藥大學醫務管理學研究所碩士班 |
| 地點 |
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全臺 全部
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| 研究內容 |
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[ 摘要 ]
目的：結核病是國內死亡人數最多的傳染病，儘管台灣地區結核病防治工作有不錯的成果，但山地鄉結核病的發生率及死亡率卻遠遠高出台灣地區。山地鄉有77.62%的人口為原住民，其生活條件、健康行為及經濟條件皆較一般民眾不佳，相對的在就醫上也遭遇較多的困難。因此本研究以整體原住民肺結核病患為研究對象，以找出影響原住民肺結核病患未完成治療之因素。
方法：依疾病管制局傳染病通報系統2004年及2005年新通報之原住民肺結核病患，共計615位，利用結構式問卷以電訪進行普查。完治族群有效樣本277份(65.18%)，未完治族群110份(57.89%)。資料分析方面，應用羅吉斯迴歸分析探討影響原住民肺結核病患未完成治療之相關因素。
結果：所有615位原住民肺結核患者中，完治者佔69.11%、未完治者30.89%。受訪者中服藥後有副作用者佔67.96%，有14.55%的個案因副作用而中斷服藥。經濟、交通因素及治療時間長為治療期間主要困擾。在原住民病患中，以經濟及交通方面之需求最大。羅吉斯迴歸分析顯示，性別、原住民族群、是否因結核病更換工作、生活品質影響程度、衛生所護士幫助性、醫生或醫院護士幫助性、酗酒情形、結核病傳染性的認知、心理及社會層面需求，皆是影響原住民肺結核患者完治與否的顯著因素(p<0.05)。
結論與建議：原住民的健康行為及疾病認知皆是影響原住民患者完治與否的因素，且醫護人員的幫助與心理及社會需求的促進，皆是改善原住民肺結核病患完治的重要努力方向。因此本研究建議衛生主管機關：(一)透過IDS計畫指派肺結核相關專科醫師至山地離島鄉協助治療；(二)提供專用交通車降低就醫障礙及避免相互感染；(三)提供完治獎金作為結核病治療之誘因；(四) 加強DOTS計畫的執行管理；(五)提升結核病通報系統品質管理。對醫護人員之建議：(一)改善部分用藥以降低副作用；(二)提升原住民肺結核病患對肺結核疾病的認知；(三)加強衛教改善其健康行為；(四)增進與病患溝通及關心。
[ 英文摘要 ]
Purpose: TB is a very serious public health issue in Taiwan. It is the most common infectious disease which can cause people die. Although the prevention of tuberculosis is effective, the death rates in mountain areas are higher than the average rate in Taiwan. The rate of aboriginal people in mountain is 77.62%. Generally, their living condition, health behaviors, and income are worse than general public. It is also more difficult for them to have enough medical care. Therefore, this study would like to investigate the factors of failed treatment for aboriginal TB patients.
Methods: This research uses the aborigine new TB cases listed in CDC between 2004 and 2005. A total of 615 patients have been reported. Structured questionnaires have been used to interview aboriginal TB patients by phone survey. The total number of the completely cured group is about 277 (65.18%) and the number of the group that has not been cured is 110 (57.89%). Logistic regression analysis is applied to examine the factors that significantly affect tuberculosis patients.
Results: In all of the 615 aboriginal TB patients, 69.11% have been cured completely; the other 30.89% have not been cured. In our survey, 67.96% of patients report that they have a side effect from their medication. Moreover, 14.55% of aboriginal TB patients stop taking the medicine because of its side effects. The problems of the treatment for aborigine TB patients include economical factor, transportation, and long period of treatment time. The most urgent needs of the aboriginal TB patients are financial support and transportation. The logistic regression analysis shows that the significant factors that influence whether aboriginal TB patients can be cured include gender, tribe, working condition, life quality, the assistance from doctor and nurse in the hospital, alcohol abuse, and the knowledge of TB infectious probability, the psychological and social needs.
Conclusions and suggestions: Both the health behavior and disease knowledge influence the factors that whether they can be cured or not. Moreover, the assistance from medical care people and the improvement of psychology and social need are important factors to enhance the rate of aboriginal people who can be cured completely. This research has some recommendations for health policy decision makers as follows: (1) Assign TB specialists to mountain areas to treat aborigine TB patients; (2) Offer specific transportation for aborigine TB patients to reduce the their difficulties of seeking medical treatment; (3) Offering the financial reward for complete treatment;(4) Execute DOTS program;(5) Enhance the quality and management for TB notification system. The recommendations for healthcare staffs are the following: (1) Modify some medication to reduce the side effect; (2) Enhance TB patients’ knowledge about tuberculosis. (3) Improve their health behaviors through health education. (4) Increase the communication and concern to patients.
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