英国城市环境中的脆弱性和结核病治疗结果:一项混合方法研究
Luis C Berrocal-Almanza1, Marcela Lima1, Helen Piotrowski1
1National Heart and Lung Institute, NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London, London, United Kingdom.
PloS one
|August 17, 2023
概括
高龄,外籍出生和多抗药结核病 (MDR-TB) 预测英国城市的治疗结果不佳. 解决社会决定因素和医疗保健整合对于脆弱的结核病患者至关重要.
科学领域:
- 公共卫生 公共卫生
- 流行病学 流行病学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 关于影响结核病 (TB) 治疗结果和伦敦以外的城市英格兰弱势群体的医疗保健优先事项的因素的证据有限.
- 这项研究通过检查伯明翰和莱斯特的结核病患者和医疗保健提供者来解决这一差距.
研究的目的:
- 确定城市英格兰结核病治疗结果差的预测因素.
- 从患者和提供者的角度了解医疗保健优先事项和导致脆弱性的因素.
- 为制定特定的结核病预防和护理政策提供信息.
主要方法:
- 一种混合方法的方法,结合了定量和定性数据.
- 对2013-2018年结核病患者队列 (n=2252) 的后勤回归分析,以确定不良结果的预测因素.
- 与25名参与者 (9名患者,16名医疗保健专业人员) 进行半结构化采访,以探索促成因素和优先事项.
主要成果:
- 年龄较大 (≥55岁),外国出生 (来自中欧,东亚,撒哈拉以南非洲) 和多抗药性结核病 (MDR-TB) 与治疗结果不佳有关.
- 发现的关键因素包括生活/工作条件不佳,福利不足,初级保健反应不佳以及治疗挑战 (持续时间,副作用).
- 医疗保健和社会服务,以及初级和二级护理之间的整合被建议作为一个解决方案.
结论:
- 年龄,MDR-TB和异国出生是伯明翰和莱斯特不良结核病治疗结果的重要预测因素.
- 患者的脆弱性和不良结果的风险是多维的,需要对护理途径的细微了解.
- 制定有针对性的支持计划需要更深入地了解特定患者的弱点及其对护理的影响.
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