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Default Risks in Home Tuberculosis Patients Regarding Japanese DOTS (Directly Observed Treatment Short-Course)
Mori R, Yanagisawa S, Matsumoto K, Takayama K and Nagata Y
Background: A default risk assessment is conducted on home-care tuberculosis patients in Japan to prepare an individual plan of nursing care and to work on DOTS. The purpose of this study is to clarify appropriate default risk items.
Methods: Data on tuberculosis patients who finished treatment during 2013 to 2015 at public health centers in four prefectures was separated into completion and failure and interruption, and conducted X2 test. Furthermore, logistic regression analysis was conducted to examine the relationship based on the evaluation results as the dependent variable.
Results: 470 subjects consisted of 439 patients (93.4%) whose treatment was completed and 31 patients (6.6%) whose treatment was interrupted. When X2 test was conducted in regards to 15 common risk items, a significant difference was observed in occurrence of side effects and history of treatment interruption. Analysis after excluding patients in facilities as well as patients under 20 years old also indicated the same results (n=417). When the 15 risk items were considered by excluding patients in facilities as well as patients under 20 years old with multiple logistic regression analysis, risk items included latent tuberculosis patients (OR: 2.59, 95% CI confidence interval: 1.11-6.02) in regards to the affected areas (pulmonary tuberculosis+ extrapulmonary tuberculosis group=1), occurrence of side effects (OR: 7.5, 95% CI 3.33-16.92), and history of treatment interruption (OR: 10.57, 95% CI:1.81-61.90). When patients whose medicine intake was directly confirmed were further excluded (n=395), risk items included affected areas (OR: 3.13, 95% CI: 1.28-7.68), occurrence of side effects (OR: 10.46; 95% CI: 4.39-24.93), and no understanding of side effects (OR: 8.19, 95% CI: 2.03-33.14).
Conclusion: As a result of narrowing down the subjects, there were eventually 15 default risk items, among which four strong risk items were suggested, including affected areas, occurrence of side effects, no understanding of side effects, and history of treatment interruption.