H-C Chou1, S-W Lin2, W-W Chen1, W-M Ke1, P-H Chao1, F-Y Hsiao2. 1. Taiwan Drug Relief Foundation, Taipei, Taiwan. 2. Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
Abstract
OBJECTIVE: To investigate adherence to liver function monitoring as recommended in Taiwan's tuberculosis (TB) diagnosis and treatment guidelines for newly diagnosed TB patients. DESIGN: Retrospective cohort study of the National Health Insurance Research Database (NHIRD), Taiwan, 2000-2011. METHODS: From the NHIRD, we identified 11 397 newly diagnosed TB patients who initiated anti-tuberculosis treatment between 2000 and 2011 and categorised these into three groups: completely, partially and non-adherent. Logistic regression was used to explore potential factors associated with the adherence rate. RESULTS: The completely adherent rate increased from 0.5% in 2000 to 9.2% in 2011, while the non-adherent rate decreased from 17.5% to 1.2%. Compared to the non-adherent group, patients with a history of liver disease (OR 4.36, 95%CI 1.92-9.87) and viral hepatitis (OR 9.39, 95%CI 1.47-60.19), as well as patients whose prescribing physicians were specialists in chest (OR 4.59, 95%CI 1.91-11.05), TB (OR 2.55, 95%CI 1.01-6.40) and infectious diseases (OR 3.93, 95%CI 1.08-14.31), had higher odds of being completely adherent to the guidelines. CONCLUSION: Our findings could serve as an important reference for developing effective strategies to improve adherence to guidelines and prevent patients from developing anti-tuberculosis drug-associated hepatotoxicity.
OBJECTIVE: To investigate adherence to liver function monitoring as recommended in Taiwan's tuberculosis (TB) diagnosis and treatment guidelines for newly diagnosed TB patients. DESIGN: Retrospective cohort study of the National Health Insurance Research Database (NHIRD), Taiwan, 2000-2011. METHODS: From the NHIRD, we identified 11 397 newly diagnosed TB patients who initiated anti-tuberculosis treatment between 2000 and 2011 and categorised these into three groups: completely, partially and non-adherent. Logistic regression was used to explore potential factors associated with the adherence rate. RESULTS: The completely adherent rate increased from 0.5% in 2000 to 9.2% in 2011, while the non-adherent rate decreased from 17.5% to 1.2%. Compared to the non-adherent group, patients with a history of liver disease (OR 4.36, 95%CI 1.92-9.87) and viral hepatitis (OR 9.39, 95%CI 1.47-60.19), as well as patients whose prescribing physicians were specialists in chest (OR 4.59, 95%CI 1.91-11.05), TB (OR 2.55, 95%CI 1.01-6.40) and infectious diseases (OR 3.93, 95%CI 1.08-14.31), had higher odds of being completely adherent to the guidelines. CONCLUSION: Our findings could serve as an important reference for developing effective strategies to improve adherence to guidelines and prevent patients from developing anti-tuberculosis drug-associated hepatotoxicity.
Authors: Conor Duncan Tweed; Genevieve Helen Wills; Angela M Crook; Rodney Dawson; Andreas H Diacon; Cheryl E Louw; Timothy D McHugh; Carl Mendel; Sarah Meredith; Lerato Mohapi; Michael E Murphy; Stephen Murray; Sara Murthy; Andrew J Nunn; Patrick P J Phillips; Kasha Singh; M Spigelman; S H Gillespie Journal: BMC Med Date: 2018-03-28 Impact factor: 8.775