IT monitoring of determinative factors in adherence to treatment of patients having tuberculosis

Transcription

1 IT monitoring of determinative factors in adherence to of patients having tuberculosis FELICIA DOGARIU 1), ANTONELLA CHESCA 2), MARIUS CRISTIAN LUCULESCU 3) MIHAELA ELENA IDOMIR 2), 1) Hospital of Pneumology Braşov 2) Faculty of Medicine, Transilvania University of Braşov 3) Faculty of Mechanical Engineering, Transilvania University of Braşov ROMANIA Abstract: - The paper presents a study on the determinative factors in producing tuberculosis, the compliance of patients to, the aspects arising from the lack of collaboration of these patients in the correct and of the disease and the risks of abandoning the therapy. The study is a retrospective one. For collecting data, it have been used a questionnaire with pre-codified questions, based on the factors considered by WHO (World Health Organization) as being determinant in adherence to of people affected with tuberculosis. The questionnaire with pre-codified questions has been applied to persons that have been registered as having tuberculosis in the county of Braşov, Romania, in 2007, being excluded from the study all the transfers, confutation of diagnostic, death and children. The dates of the study have been processed by the SPSS 13.0 program. The initial idea is now transposed in a web questionnaire which stores this information in a database for subsequent statistical preparation and analysis. Keywords: - tuberculosis, patients, socio-economical factors,, compliance, monitoring 1 Introduction The of tuberculosis involves a real concern of the patient regarding his health. The social worker has an essential role in the therapeutical success, through which it may be possible to increase patient adherence to the antituberculosis. This requires some time and should be followed strictly, allowing the socioprofessional reintegration of the patients after the healing of the disease [1]. According to the National Program of Tuberculosis Control (NTPC) from 2007 to 2011, it is defined as a drop, a patient who discontinued tuberculostatic for more than 2 consecutive months or more than of total intakes indicated. The adherence to is important because tuberculosis may be curable in most cases only if the patient follows strictly the prescribed by a physician specialist in pneumology [11]. Five categories of determinant factors are considered as being involved in adherence to of tuberculosis (Fig. 1), namely: a) Factors related to the disease b) Factors involving the health system c) Factors strictly related to the disease d) Socio-economical factors e) Factors related to the patient 1.1 Critical Overview The factors related to the of the tuberculosis involve medical aspects, associated adverse effects of therapy and the complex regime of. In this context, an important risk factor contributing to the lack of complete healing of the disease is the abuse of certain categories of substances like drugs or alcohol. ISSN: ISBN:

2 Figure 1 - Determinant factors in adherence to the of tuberculosis This aspect was demonstrated by studies conducted by Garret L. et al., in 2002, in Atlanta, Georgia, on a group of patients hospitalized with tuberculosis in a public hospital. The study has showed the drug and alcohol abuse at men younger than 45 years, of African-American origin [2]. In order to establish an appropriate to cure tuberculosis, it is required to take certain measures and strategies through the involvement and collaboration with local authorities, according to equal rights [3]. According to the ethical principles, the clinician can provide only healing disease through patient adherence to the prescribed. Without an effective of this infectious disease, it is possible emergence of microbial resistance to tuberculostatics, fact noted by Pablos- Mendey A. et al. [4, 5]. New technologies evolution raises the risk of transforming the human relationships from direct, unmediated relations into indirect, mediated by internet relations and also the risk of transforming the physician into a professional addicted to machines. [7] It is also important to mention that the students from faculty of medicine have the same positive perception about using technologies in other studies made, about e-health. [8]. Factors involving the health system are complex. They relate primarily to patient suffering from tuberculosis belonging to his family doctor. In this context, it is considered the poor relationship with the family doctor and the distance to his office. Also, it is of interest the level of health services, the percentage of medical staff inadequately trained to treat the disease and also their inability to early identify potential patients that will not have adherence to [11]. The factors strictly related to disease have an important contribution in the dialogue between the doctor and the patient performing the patient's psychological profile [9]. In this context, the named factors include alcohol or drug abuse, depression and psychological stress, altered mental status of patients and asymptomatic patients. Socio-economical factors that contribute to disease are related to the residence of the patient, his stable income, environment and ethnicity [6]. The factors related to the patient concerns his cultural beliefs about illness and, the hope for recovery and social reintegration of the patients, language barriers or low knowledge about tuberculosis and its and patient isolation due to stigma of the disease [12, 13]. According to studies conducted by Zignol M. et al., in 2006, it is considered that if a patient is not adherent to, the disease may have a longer duration, multidrug-resistant tuberculosis may be developed and spread or the patient may die due to a discontinued [10]. According to the above, the study aimed to identify the relationship between the determinative factors in low adherence to and the therapeutical abandonment in patients diagnosed with tuberculosis, involving new cases. The retrospective study was done in the county of Braşov, Romania, in Method For the study, a questionnaire with pre-codified questions has been built (Fig. 2). This type of questionnaire is based on factors considered by the WHO (World Health Organization) as being determinants in patient adherence to. The mentioned factors are socio-economical, related to healthcare, related to the disease itself and to the of tuberculosis, in close relationship with the patient's attitude in the context of the need of treating the disease. The questionnaire was applied for the new cases diagnosed with tuberculosis that have been accumulated in There were excluded from this study the transfers, denials, deaths and children. 3. Results The results are grouped according to the factors mentioned in Figure Questionnaire results Regarding the influence of the socio-economical factors, the results, in absolute values, are presented in Table 1. ISSN: ISBN:

3 Age Gender Rural/ Urban Do you have a stable home (even if not personal property)? Do you have a family doctor? Do you have a poor relationship with your family doctor? Is it a long distance to the family doctor's office (is it necessary to use means of transport to it)? Do you have stable income (salary, pension)? Do you benefit of welfare (to be completed only for those without stable income) or other forms of support from the society (food coupons, etc.)? Are you consuming alcohol / other drugs (a.o.)? Do you have associated medical problems that may make the more difficult? Do you have adverse drug reactions? Are you concerned about problems that occurred as a result of the disease (such as loss of employment, marginalization by colleagues, the impact of disease on family income, etc.)? If appropriate state Do you hope to have a low recovery and social reintegration? Are there language barriers or poor knowledge about disease and? Do you have strong cultural and personal beliefs which will enable the, use the "cures" deeming them more effective than drug? Do you foresee in the following six months events that prevent you from making? Figure 2 - The questionnaire used to monitor the determinative factors of adherence to in patient with tuberculosis. The graphical percentage representation has been done in Figure 3 through Figure 6. Areas urban rural man 128 Gender woman stable 191 Housing not stable 4 stable 128 not stable Income Table 1 The distribution of patients related to social environment 82,7 % 80,7 % 17,3 % 19,3 % urban rural Figure 3 The distribution of patients related to genre 80,5 % 85,1 % 19,5 % 14,9 % men woman Figure 4 The distribution of patients related to their residence 25 % 83,3 % 75 % 16,7 % stable housing not stable housing Figure 5 The distribution of patients related to their income 71,7 % 87,5 % 28,3 % 12,5 % stable income not stable income Figure 6 ISSN: ISBN:

4 Regarding the influence of the factors related to the health system, the obtained results are presented in Table 2. Family doctor with without Relationship with family doctor poor good Distance to the family doctor s office high distance 35 low distance Table 2 Regarding the influence of the factors related to the disease (consumption of alcohol or other drugs), the results are shown in Table 3 and Figure 7. consumption of alcohol or other drugs 8 consumers not consumers 140 Table 3 Disease perception preoccupied not preoccupied 127 Hope of recovery and social reintegration low hope good hope Distribution of patients based on the language and knowledge about disease and with language barriers or poor knowledge about disease and without language barriers or poor knowledge about disease and incomplete Table 4 complete incomplete complete The distribution of patients related to the disease perception The distribution of patients related to the consumption of alcohol or other drugs 91,7 % 79,9 % 8,3 % preoccupied 20,1 % not preoccupied 71,4 % 28,6 % 83,8 % 16,2 % Figure 8 The distribution of patients related to the disease perception consumers not consumers Figure 7 Regarding the influence of the factors related to the patient (disease perception, hope of recovery and social reintegration, distribution of patients based on the language and knowledge about disease and ), the results, in absolute values, are presented in Table 4 and the percentage representation in Figure 8 through Figure ,2 % 27,8 % low hope 83,1 % 16,9 % good hope Figure 9 ISSN: ISBN:

5 The distribution of patients patients based on the language and knowledge about disease and 70,0 % 85,2 % 30,0 % 14,8 % with poor knowledge without poor knowledge Figure IT monitoring of patients having tuberculosis The initial idea of collecting data using printed questionnaires is now transposed into an electronic form, taking into account obvious advantages offered by such a solution: ease of data collection; remote access from any computer using Internet; efficient pooling of information; simple data processing; statistical analysis; export of the results in different formats and so on. For doing this, a special web questionnaire was designed, using the free software LimeSurvey [14], a flexible package that can allow unlimited number of surveys working at the same time, unlimited number of questions in a survey and no limit number of participants to the survey. Information is stored in a database for subsequent statistical preparation and analysis. Two versions of the questionnaire are available now; one was made in Romanian language, in the form of a web page accessible at: 34&newtest=Y&lang=ro and the other was made in English language, accessible at: 34&newtest=Y&lang=en A part of the last one is presented in Fig. 11. The information is stored in a database which can always be exported to software like Excel, SPSS, etc., where appropriate analysis could be generated. Following this analysis there can be established priority measures to be taken in order to increase the adherence to tuberculosis. Currently, we work on implementing monitoring software of the evolution in time of the patients in order to see the effectiveness of the taken measures. Figure 11 - The electronic form of the questionnaire used for tuberculosis patients monitoring 4. Conclusion The study shows that the risk of abandonment in new cases of tuberculosis is represented by the socioeconomical and the educational factors. Also there were identified as independent risk factors associated with early therapy, without a steady income, a stable home and a low educational ISSN: ISBN:

6 level. The mentioned factors, together with the alcohol abuse, are common characteristics in males. In this context, it is very important to find appropriate solutions to enable the monitoring of for those who do not have stable housing and that require hospitalization in medical and social establishments. From this perspective, research can continue in certain populations, of different social environment and areas, with a particular culture and ethnicity. Particular emphasis is given to health education level, which entails giving attention to to cure tuberculosis and establishment of educational measures. These concern the need to administered medication but also to establish measures to educate patients on their adherence to. It is also necessary to establish intervention plans for tuberculosis patients with no stable income, realized in some incentives for continuing the or implementing of cooperation measures with local authorities, in order to provide welfare for subsistence. All the above aspects contribute to early detection of risk of abandonment of for the patients which are diagnosed with tuberculosis. Measures to be imposed and which were mentioned above aimed at improving the success rate in the meant to cure this disease. References: [1] Cheşcă A., Dogariu F., Rogozea L. - Ethical aspects related to counseling patients suffering from tuberculosis, Revista Română de Bioetică, vol.: 8, issue: 1, pg: , [2] Garrett L., Betrayal of Trust: The Collapse of Global Public Health, New York: Hyperion, 2000, pp [3] Gostin L.O., Berkman B., Project on Addressing Ethical Issue in Pandemic Influenza Planning (Geneva: WHO, 2007). Available at eth/ethics/ PI_Ethics_draft_paper_WG2_6_Oct_06.pdf (accessed on July 26, 2010). [4] Idomir M. E., Rogozea L., Nemet C. G., Webservices for monitoring the resistance to antibiotics of pathogen germs, Proceedings of the 11th WSEAS/IASME International Conference on Mathematical Methods and Computational Techniques in Electrical Engineering (MMACTEE 09), Vouglianemi Athens, Greece, September 28-30, 2009, pp [5] Pablos-Mendey A., Knirsch C.A., Barr R.G., Lernen B.H., Frieden T.R., Nonadherence in Tuberculosis Tratment: Predictors and Consequences in New York City, American Journal of Medicine, 102, 1997, pp [6] Pineat G., Good Practice in Legislation and Regulation for TB Control: An Indicator of Political Will (Geneva: WHO, 2000). Available at /WHO_CDS_TB_ pdf (accessed on July 26, 2010). [7] Rogozea L., Repanovici A., Cristea L., Baritz M., Miclăuş R., Pascu A., Ethics and human behaviour two topics for medical engineering students, Proceedings of the 4th WSEAS/ IASME International Conference on Educational Technologies (EDUTE 08), Corfu, Greece, October 26-28, 2008, pp [8] Rogozea L. - Towards ethical aspects on artificial intelligence, The 8th WSEAS International Conference on Artificial Intelligence, Knowledge Engineering and Data Bases, Date: Feb 21-23, 2009 Cambridge England, Source: Proceedings of the 8th WSEAS International Conference on Artificial Intelligence, Knowledge Engineering and Data Bases, pg: , [9] Rogozea L., Miclăuş R., Nemet C., Bălescu A., Moleavin I., Education, Ethics and E- Communication in Medicine, WSEAS- International Conferences - Santander, Cantabria, Spain Sept [10] Zignol M. et al., Global Incidence of Multidrug-Resistant Tuberculosis, Journal of Infectious Diseases, 194, 2006, pp [11] Ministerul Sănătăţii Publice, Departamentul Central de Management al PNCT, Institututul Naţional de Pneumologie Marius Nasta Bucureşti, 2007, Ghid metodologic de implementare a Programului Naţional de Control al Tuberculozei, , [12] World Health Organization, The World Health Report 2004: Changing History (Geneva: WHO, 2004). [13] World Health Organization, Global Tuberculosis Control Surveillance, Planning, Financing (Geneva: WHO, 2008). [14] (accessed on July 26, 2010). ISSN: ISBN: