提升肺結核病人社區都治計畫率方案

A Program to Increase the Participation Rate in DOTS (Direct Observed Treatment, Short Course) of Tuberculosis Patients in the Community

背景：結核病是國內法定傳染病發生率第一位，為提升結核病人的完治率，短期直接觀察治療法（簡稱都治，direct observed treatment, short-course [DOTS]），被視為最有效之策略。目的提升出院後肺結核病人加入社區都治計畫，讓病人回到社區後能持續接受藥物治療六～九個月，以提升治癒成效。解決方法經現況分析後發現病人對社區都治計畫內容不了解、護理人員不清楚社區都治執行方式、護理人員缺乏社區都治計畫相關在職教育、缺乏社區都治計畫的指導單張及輔助教材，經修訂輔助教材、舉辦護理人員在職教育、邀請醫師及社區關懷員加入宣導、製作加入都治計畫口訣提醒牌等，為本專案之改善策略。結果肺結核病人出院後願意加入社區都治計畫者從27.1%提升至96.3%；而護理人員的認知率也自86.3%提升至100%。結論本專案除能有效地提升肺結核病人出院後願意加入社區都治計畫率，亦能提高治癒率及完治率，協助政府的「結核病十年減半全民動員計劃」能早日達成。

Background & Problems: Tuberculosis (TB), a disease subject to mandatory reporting, is widely distributed in our country. The Direct Observed Treatment, Short-course (DOTS) is an effective protocol to increase TB treatment success.Purpose: We developed a program in our hospital to increase discharged patient participation in DOTS, which helps ensure they receive 6 to 9 months of post-discharge medication therapy to maximize treatment outcomes.Resolution: We identified four key problems related to low TB patient participation in DOTS. These included (1) patients did not understand the DOTS program; (2) staff did not know how to conduct the DOTS protocol; (3) staff had not received in-service DOTS education; and (4) the hospital had no DOTS patient education or teaching aids available. To improve TB patient participation in DOTS, we revised patient education material, provided continuing education to nursing staff, invited physicians and community co-workers to join in the outreach program, and made posters to remind discharged patients to sign up for the DOTS program.Results: Patient participation in DOTS rose from 27.1% to 96.3% and nursing staff knowledge of DOTS rose from 86.3% to 100%.Conclusions: This program effectively increased TB patient motivation to join DOTS after hospital discharge and also improved successful recovery and treatment completion rates. Increasing post-discharge TB patient participation in the DOTS protocol is an effective strategy for achieving the national goal of reducing TB cases by 50% within ten years.