直接観察された治療と治療の遵守
J Volmink1, P Matchaba, P Garner
1South African Cochrane Centre, Medical Research Council, Cape Town, South Africa. jvolmink@mrc.ac.za
Lancet (London, England)
|April 25, 2000
まとめ
結核の治療のための直接観察療法 (DOT) は,単に患者を観察する以上のことを含む. 成功したDOTプログラムは,直接的な観察を超えて複数のコンポーネントを活用して,薬の遵守を改善します.
科学分野:
- 公衆衛生は公衆衛生である.
- 感染症管理 感染症管理
- 医療サービス 研究 医療サービス
背景:
- 薬を服用している患者の直接観察は,結核治療の完了率を改善するための戦略です.
- 直接観察療法 (DOT) プログラムの実施には,患者の遵守に影響を与える複雑な一連の介入が含まれています.
- 政策立案者は,プログラム実施の成功のために,これらの多面的なインプットの明確な理解を必要とします.
研究 の 目的:
- 直接観察療法 (DOT) プログラムの公表報告書を体系的に特定し,レビューする.
- 世界保健機関 (WHO) の短期的なDOT戦略と様々なDOTプログラムの投入を比較する.
- DOTプログラムの成功に貢献するコンポーネントを明確にする.
主な方法:
- DOTプログラムに関する公表されたレポートの体系的な文献レビュー.
- 特定されたDOTプログラムインプットの比較分析とWHOのDOT戦略の比較分析.
- プログラムコンポーネントの質的合成と,遵守への潜在的な影響.
主要な成果:
- DOTのプログラムには,WHOの戦略の5つのコア要素以上のものが含まれていることが多い.
- 一般的に含まれている追加の構成要素には,インセンティブ,デフォルトトレーシング,法的制裁,患者中心のアプローチ,スタッフの動機付け,監督,および外部資金が含まれます.
- DOTプログラムの成功には,直接的な観測だけではなく,複数の要素の組み合わせが影響しているようです.
結論:
- 直接的な観察だけでは,結核治療の遵守率を向上させるのに十分な焦点ではないかもしれません.
- DOTプログラムの成功は,さまざまなプログラムインプットの複雑な相互作用に起因する可能性があります.
- WHOは,政策立案者や実践者を導くために,DOTプログラムの成功に貢献する複数のコンポーネントを明示的に詳細に記載すべきである.
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