Development of guidelines for implementing TB program of Nakhon Phanom Province, for care the new pulmonary tuberculosis patients, risk among of death on during TB treatment, Nakhon Phanom Province

Abstract

Objective : This study aims to know the root cause of death in new tuberculosis patients and find guideline to improve quality of care in tuberculosis patients who have risk to dead. Material and Methods : This is a retrospective study which study about new tuberculosis patients who dead and success during register in Nakhonphanom province from TBCM ONLINE program. There are 12 hospitals in Nakhonphanom province. The duration for data collection is 1 October 2017 – 30 September 2018. After data collection checking , identifying password was done for data analysis by using statistical package program. Using Chi-Square to analyze factors which related to dead in tuberculosis patients, factors with p-value < 0.05 were used to analyze by Multiple logistic regression. Result : A total of patients register TBCM ONLINE program 516 case, 186 success, 48 deaths, 319 on treatment and 9 others. Study the characteristics of patients who died with patients who had success. using Chi-Square to analyze factors which related to dead and success in tuberculosis patients, factors with p-value <0.05 were used to analyze by Multiple logistic regression. The study found that factors which related to dead in new tuberculosis patients are patients aged 65 years and over have a chance to die more than those younger than 65 years old to 2.995 times 95% CI 1.476% – 6.118%) and patients who have DOT by health care provider or voluntary health care worker dead less than patients who have DOT by family member 77.4% (95% CI 0.106%- 0.4272%). The factors which related to dead in new tuberculosis patients were plan to improve quality of care for tuberculosis patients who have risk of dead in Nakhonphanom province by using After Action Review: AAR. The study found that the new register tuberculosis patients were analyzed from meeting workers who work in hospital and district about care process for new in tuberculosis patients who have risk of dead in Nakhonphanom province in 4 aspects as following: 1) Improve individual patient care manager. 2) Improve patient care center system. 3) Improve screening patients who have risk of dead. 4) Improve DOT monitoring. The outcome for the first three months period 1/2019 found success rate in new case tuberculosis patient was 86.76% , dead rate was 8.09%, and screening rate in risk group was 75.14%. Conclusion : Patients aged 65 years and older and DOT by family member relatives were associated with deaths of pulmonary tuberculosis patients. Development of guidelines for implementing TB program of Nakhon Phanom Province, for care the new pulmonary tuberculosis patients, risk among of death on during TB treatment, Nakhon Phanom Province. Affect performance indicators improved trend.