耐多药肺结核及其患者治疗依从性的护理措施研究进展

耐多药结核病的出现与流行,危害人类健康的同时,也给社会经济带来了巨大损失,成为全球结核病防控工作最主要的威胁之一,使得结核病防控面临严峻考验。作者从耐多药结核病的流行现状、发生原因及解决患者治疗依从性的护理措施研究等方面进行综述,为加强耐多药肺结核患者的护理研究提供科学的参考依据。     

Low perceived service quality in community pharmacy is associated with poor medication adherence

ObjectiveCommunity pharmacists are highly accessible healthcare professionals, whose regular contact with patients provides ongoing opportunities to improve medication safety and promote medication adherence. This study investigates whether patients who experience low service quality in community pharmacies are less adherent to their regular medications.MethodsEight Australian pharmacies were recruited, 5 self-identified as having a price promotion business strategy and 3 with a service-focused business strategy. Patients taking regular prescribed medicines who had previously attended the pharmacy completed e-surveys in-store with measures of perceived service quality (pSQ) and self-reported adherence. Multivariate regression using multilevel modelling with bootstrapping was used to explore the relationships between variables.ResultsSurveys were completed by 319 respondents. Attending pharmacies with a price promotion business strategy was predictive of lower pSQ and poor medication adherence. The between-pharmacy slope of the relationship between pSQ and adherence was 2.25 (with 95 % confidence intervals = 1.50, 2.86) and was highest in pharmacies with lowest pSQ.ConclusionThis study highlights that when patients experience low service quality, in community pharmacies they are more likely to report poor adherence to their regular prescribed medicines.Practice implicationsCommunity pharmacies need to be designed and managed to allow pharmacists to provide high levels of patient-centred care.     

特殊疾病医疗保险对糖尿病患者治疗费用的影响及相关因素分析

目的比较重庆市已纳入慢病管理系统2型糖尿病患者中，有、无特殊疾病医疗保险（简称特病医保）者之间的治疗费用情况及可能影响申请该特病医保的因素。方法采用结构化问卷，调查患者的基本信息及与糖尿病有关的药房、门诊、住院治疗费用情况。使用SAS 9.1软件进行数据统计分析，计数资料分析采用 χ ²检验，有统计学差异的变量再纳入多因素逐步logistic回归模型。连续性变量用中位数（四分位数间距）[ M（ Q）]来表示，采用Wilcoxon秩和检验。 结果门诊组有特病医保的患者年人均总费用[2160（3081）元]较无特病医保的患者高[1000（2100）元， P < 0.01]，年次均自费比例（54.04%）低于无特病医保患者的自费比例（93.78%， P < 0.01）。就申请特病医保而言，中等收入水平（ OR=1.94）、高收入水平（ OR=2.11）、参加城镇职工医疗保险（ OR=4.19）、病程超过5年（ OR=2.04）都是其可能的影响因素，具有这些特征的患者相对更容易申请到特病医保。 结论为缓解2型糖尿病患者经济负担，政府应大力宣传特病医保的相关政策，鼓励患者主动了解，积极申报。同时，医保部门与医疗机构应加强监管，简化办理流程，建议增加特殊疾病定点零售药店的数量和覆盖面，提高特病医保利用的可及性。同时，应更加关注低收入人群和病程相对较短的患者，增强他们抵御疾病经济风险的能力，提高特病医保的利用及公平性。     

Factores asociados a la adherencia en el tratamiento de la infección tuberculosa

ObjectiveTo analyze adherence to treatment of tuberculosis infection and to identify risk factors for its compliance.DesignAn observational historical cohort study.SettingHospital Universitari Sant Joan d’Alacant (Alicante).ParticipantsAll patients with a tuberculin skin test (TST) done during tuberculosis contact tracing during 6 years.ResultsWe included 764 tuberculosis contacts in the analysis. 59.7% of the 566 patients who completed the contact tracing, had tuberculosis infection (TI). Of the patients with TI, 45.6% had not started treatment for tuberculosis infection (TTBI). Factors associated with not starting TTBI were: age (36-65 years, RR: 5.8; 95% CI: 1.2-27.5, and > 65 years, RR: 11.3; 95% CI: 2.0-64.0), the social relationship with TB case (RR: 2.2; 95% CI 1.2-3.8), and the TST reaction (≥ 15 mm; RR: 0.5; 95% CI: 0.3-0.9). The completion rate for TTBI was 80.4% among people who started therapy. The treatment regimen was associated with greater compliance to TTBT (7-9H, RR: 12.7; 95% CI: 1.5-107.3).ConclusionsThe treatment compliance rate of Tuberculosis infection was high among people who started therapy. Almost a half of the contacts with TI did not start treatment, and associated factors were: age, social relationship, and the TST reaction. The treatment regimen was associated with greater compliance. It is important to know the factors associated with adherence to treatment of TI in each health area, and focus efforts on risk groups; thereby approaching the global control of tuberculosis.     

Total Joint Arthroplasty: Trends in Medicare Reimbursement and Implant Prices

Total joint arthroplasty (TJA) continues to be a popular target of cost control efforts. In order to provide a unique overview of financial trends facing TJA, we analyzed Medicare databases including 100% of beneficiaries, as well as industry surveys of implant list prices. Although there was a substantial increase in TJA utilization over the period 2000–2011 (+ 26.9%), growth has been stagnant since 2005. New coding schemes have made complicated cases more lucrative for hospitals (+ 2.5% to 6.5% per year), while reimbursements for uncomplicated cases have fallen (− 0.7% to − 0.6%). Physician reimbursements have declined on all case types (− 2.5% to − 2.1% per year), while list prices of orthopedic implants have risen (+ 4.8% to 5.5%). These trends should be kept in mind while contemplating future changes to TJA payment.     

某院392例不良反应报告分析

目的：分析探讨某院药物不良反应产生的原因和类型,为合理用药提供指导,促进用药安全,减轻患者痛苦.方法：利用回顾性分析方法,分析患者在治疗期间产生的不良反应类型及其原因,统计分析,得出结论.结果：患者所发生的不良反应中抗菌药比例高达59.95%,相比于其它种类的药物,不良反应发生率明显升高,P＜0.05,具有统计学意义.在各种不良反应之中,消化系统和全身性系统的不良反应种类所占比例相较于其他种类明显增多,P＜0.05,具有统计学意义.结论：在临床用药的过程中,要做到合理用药,尽量减少抗菌药物的应用,同时要建立监测和预防机制,减少不良反应的发生,使患者平安度过病程,恢复健康.     

抗糖尿病药致不良反应的文献分析

目的：探讨抗糖尿病药致不良反应发生的情况,为临床合理用药服务。方法：通过中国期刊全文数据库（CNKI）收集1998-2011年发表的抗糖尿病药致不良反应发生的相关文献,对不良反应发生的患者性别与年龄构成、发生时间分布、累及器官或系统、药品种类等进行汇总、分析。同时对糖尿病并发症相关药物的不良反应亦做了归纳与分析。结果：抗糖尿病药引发不良反应的年龄主要集中于51岁以上;发生时间主要集中于1d～2个月;累及器官或系统涉及全身各大系统,其中最常见的为胃肠道反应;严重不良反应主要发生于心血管系统、免疫系统、内分泌系统中,包括室性早搏、低血糖性昏迷、过敏性休克、全身剥脱性皮炎甚至死亡等。结论：糖尿病及其并发症治疗药物产生的不良反应是广泛的,有些甚至是严重的;广大临床医师及药师应对其进行密切的监测,积极推进抗糖尿病药临床合理使用。