Protocol for a randomised controlled trial to evaluate the effectiveness of improving tuberculosis patients’ treatment adherence via electronic monitors and an app versus usual care in Tibet

Wei, Xiaolin; Hicks, Joseph Paul; Pasang, Pande; Zhang, Zhitong; Haldane, Victoria; Liu, Xiaoqiu; Wang, Lixia; Shi, Dachun; Ge, Shiliang; Walley, John; Upshur, Ross; Hu, Jun

doi:10.1186/s13063-019-3364-x

Cited by 20 publications

(30 citation statements)

References 31 publications

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“…However, many studies have emphasized the importance of exploring the use of innovative electronic health (e-health) technology in disease case management to improve patient adherence and treatment outcomes. 36,[38][39][40][41][42] Some studies found it was easier to monitor adverse events and non-adherent behavior through mobile phone messaging, and one study in China found that using an electronic medication monitor (EMM) which provides regular reminders to take medication reduced poor-adherence behaviors. E-health management may be a more preferred management method 42 and should be integrated into future MTCM delivery systems.…”

Section: Discussionmentioning

confidence: 99%

Adherence to Multidrug Resistant Tuberculosis Treatment and Case Management in Chongqing, China – A Mixed Method Research Study

Xing¹,

Zhang²,

Jiang³

et al. 2021

IDR

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This paper evaluated the treatment adherence for multidrug-resistant tuberculosis (MDR-TB) and MDR-TB case management (MTCM) in Chongqing, China in order to identify factors associated with poor treatment adherence and case management. Methods: Surveys with 132 MDR-TB patients and six in-depth interviews with health care workers (HCWs) from primary health centers (PHC), doctors from MDR-TB designated hospitals and MDR-TB patients were conducted. Surveys collected demographic and socioeconomic characteristics, as well as factors associated with treatment and case management. In-depth interviews gathered information on treatment and case management experience and adherence behaviors. Results: Patient surveys found the two main reasons for poor adherence were negative side-effects from the treatment and busy work schedules. In-depth interviews with key stakeholders found that self-perceived symptom improvement, negative side-effects from treatment and financial difficulties were the main reasons for poor adherence. MDR-TB patients from urban areas, who were unmarried, were female, had migrant status, and whose treatments were supervised by health care workers from primary health clinics, had poorer treatment adherence (P<0.05). Among the MDR-TB patients surveyed, 86.7% received any type of MTCM in general (received any kind of MTCM from HCWs in PHC, MDR-TB designated hospital and centers of disease control/TB dispensaries and 62.50% received MTCM from HCWs in PHC sectors). Patients from suburban areas were more likely to receive both MTCM in general (OR=6.70) and MTCM from HCWs in MDR-TB designated hospitals (OR=2.77), but female patients (OR=0.26) were less likely to receive MTCM from HCWs in PHC sectors, and patients who were not educated about MTCM by TB doctors in designated hospitals were less likely to receive MTCM in general (OR=0.14). Patients who had not been hospitalized were less likely to receive MTCM from HCWs in MDR-TB designated hospitals (OR=0.21). Conclusion: Stronger MTCM by HCWs in PHC sectors would improve treatment adherence among MDR-TB patients. Community-based patient-centered models of MTCM in PHC sectors and the use of digital health technology could help to improve case management and thereby improve adherence.

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Section: Discussionmentioning

confidence: 99%

Adherence to Multidrug Resistant Tuberculosis Treatment and Case Management in Chongqing, China – A Mixed Method Research Study

Xing¹,

Zhang²,

Jiang³

et al. 2021

IDR

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“…However, there is a global consensus that TB patients' medicationtaking behavior must be managed. Therefore, in addition to strengthening patient knowledge of PTB treatment, on the one hand, the self-management capability of PTB patients must be strengthened; on the other hand, because DOT is difficult to implement in Tibet and has disadvantages, 7,26 it is necessary to find feasible alternative strategies to DOT, such as video-observed treatment, wirelessly observed therapy, short message service reminders and medication reminders, [27][28][29][30] to improve medication adherence among PTB patients in Tibet.…”

Section: Discussionmentioning

confidence: 99%

“…5 The national TB survey reported that 25.3% of TB patients missed more than one dose of anti-TB drugs. 6 In Shigatse, a city in the Tibet Autonomous Region, the rate of default from TB treatment was 28% in 2016, 7 which was higher than the WHO recommendation of less than 10%. 8 Medication nonadherence has been an important driver of TB drug resistance in Tibet and has resulted in treatment failure, disease relapse, prolonged infection, and even death.…”

Section: Introductionmentioning

confidence: 94%

“…8 Medication nonadherence has been an important driver of TB drug resistance in Tibet and has resulted in treatment failure, disease relapse, prolonged infection, and even death. 4,7,9 It is also one of the most significant obstacles to TB control worldwide. 10 Different studies have shown that there are many factors influencing medication nonadherence among PTB patients.…”

Section: Introductionmentioning

confidence: 99%

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<p>Factors Influencing Medication Nonadherence to Pulmonary Tuberculosis Treatment in Tibet, China: A Qualitative Study from the Patient Perspective</p>

Zhang¹,

Yang²,

Qiao³

et al. 2020

PPA

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Medication nonadherence is one of the most significant obstacles to tuberculosis (TB) control worldwide. Identification of the factors associated with medication nonadherence is important. However, few related studies have been carried out in Tibet. This study aimed to explore factors influencing medication nonadherence to pulmonary TB (PTB) treatment in Tibet, China, from the patient perspective. Patients and Methods: In this qualitative study, seventeen PTB patients in Tibet were recruited by purposive and maximum variation sampling methods. In-depth semistructured interviews were conducted to collect data on factors influencing medication nonadherence, and Colaizzi's seven-step method was used to analyze the data. Results: The medication nonadherence of PTB patients in Tibet was influenced by one or a combination of the following four factors. First, patient-related factors included a lack of knowledge of PTB treatment, poor self-management capability, poor self-regulation capability and misperception of health condition. Second, a medication-related factor was medication side effects. Third, health service-related factors included the poor treatment skills of doctors in primary hospitals and a lack of directly observed treatment (DOT). Last, sociocultural factors included the effect of traditional Tibetan medicine, lack of family member support and discrimination. Conclusion: Multiple interplaying factors influenced medication nonadherence during PTB treatment in Tibet, and the main influencing factors were a lack of knowledge about PTB treatment, poor self-management capability, and the effect of traditional Tibetan medicine. TB health workers in Tibet should provide permanently viewable PTB treatment knowledge materials to PTB patients when oral health education is conducted, find feasible alternative strategies to DOT and establish links to traditional Tibetan medicine hospitals.

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“…This app has previously been effectively used in mass public health education programmes [27,28]. In Tibet, we have employed the WeChat app to link with electronic medical records (EMR) and monitoring boxes to support tuberculosis patients in completing their treatment under harsh travel conditions [29].…”

mentioning

confidence: 99%

An antibiotic stewardship programme to reduce inappropriate antibiotic prescribing for acute respiratory infections in rural Chinese primary care facilities: study protocol for a clustered randomised controlled trial

Zhuo

Wei

Zhang

et al. 2020

Preprint

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Background: Inappropriate prescribing of antibiotics for acute respiratory infections at primary care level represents the major source of antibiotic misuse in healthcare, and is a major driver for antimicrobial resistance worldwide. In this study we will develop, pilot and evaluate the effectiveness of a comprehensive antibiotic stewardship programme in China's primary care hospitals to reduce inappropriate prescribing of antibiotics for acute respiratory infections among all ages.Methods: We will use a parallel-group, cluster-randomised, controlled, superiority trial with blinded outcome evaluation but unblinded treatment (providers and patients). We will randomise 34 primary care hospitals from two counties within Guangdong province into the intervention and control arm (1:1 overall ratio) stratified by county (8:9 within-county ratio). In the control arm, antibiotic prescribing and management will continue through usual care. In the intervention arm, we will implement an antibiotic stewardship programme targeting family physicians and patients/caregivers.The family physician components include: 1) training using new operational guidelines, 2) improved management and peer-review of antibiotic prescribing, 3) improved electronic medical records and smart phone app facilitation. The patient/caregiver component involves patient education via family physicians, leaflets and videos. The primary outcome is the proportion of prescriptions for acute respiratory infections (excluding pneumonia) that contain any antibiotic(s). Secondary outcomes will address how frequently specific classes of antibiotics are prescribed, how frequently key nonantibiotic alternatives are prescribed and the costs of consultations. We will conduct a qualitative process evaluation to explore operational questions regarding acceptability, cultural appropriateness and burden of technology use, as well as a cost-effectiveness analysis and a long-term benefit evaluation. The duration of the intervention will be 12 months, with another 24 months post-trial longterm follow-up.Discussion: Our study is one of the first trials to evaluate the effect of an antibiotic stewardship programme in primary care settings in a low-or middle-income country (LMIC). All intervention activities will be designed to be embedded into routine primary care with strong local ownership.Through the trial we intend to impact on clinical practice and national policy in antibiotic prescription

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Protocol for a randomised controlled trial to evaluate the effectiveness of improving tuberculosis patients’ treatment adherence via electronic monitors and an app versus usual care in Tibet

Cited by 20 publications

References 31 publications

Adherence to Multidrug Resistant Tuberculosis Treatment and Case Management in Chongqing, China – A Mixed Method Research Study

Adherence to Multidrug Resistant Tuberculosis Treatment and Case Management in Chongqing, China – A Mixed Method Research Study

<p>Factors Influencing Medication Nonadherence to Pulmonary Tuberculosis Treatment in Tibet, China: A Qualitative Study from the Patient Perspective</p>

An antibiotic stewardship programme to reduce inappropriate antibiotic prescribing for acute respiratory infections in rural Chinese primary care facilities: study protocol for a clustered randomised controlled trial

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