Patients with tuberculosis are required to take medicine on a full-course and regular basis due to the long courses of tuberculosis with the chronic and delayed features. Besides, the problems of discharged patients’ treatment compliance emerged, such as missing doses, stopping taking medicine or missing the re-examination appointments. Compared with the non-drug resistant tuberculosis, treatment of drug resistant tuberculosis (especially multi-drug resistant TB, MDR-TB/extensively drug-resistant TB, XDR-TB) requires more drug combinations, which means lower efficacy, long-course therapy and worse tolerance. On average, only 22–26% of the XDR-TB patients in the world successfully completed anti-tuberculosis therapy9. At present, drug resistant tuberculosis has become one of the most important public health issues, which has a negative effect on the global containment of tuberculosis by 2035 and the elimination of tuberculosis by 2050 proposed by World Health Organization (WHO). According to the 2017 Global Tuberculosis Report released by WHO, the incident number of tuberculosis in the world reached 10,400,000 in 2016, among which new cases of MDR-TB and rifampicin drug resistant tuberculosis were 600, 000 and new cases of XDR-TB reached 30, 00010. However, the current management mode of MDR-TB patients has hit a bottleneck. For example, it is difficult to improve patients’ treatment compliance and completion rate. Therefore, it is very urgent to explore a new management mode to better ensure patients’ successful treatment, hence reducing public health hazard.
Multi-disciplinary cooperative complete management mode is realized by a team made up of medical staff from different disciplines and professional background, and it demonstrates a new orientation of exploration and development for medical institutions in China. By means of this mode, multi-faceted nursing knowledge propaganda, education and instructions can be provided for patients, which forms a set of systematic, standardized and comprehensive nursing procedures and aims to improve patients’ awareness of their diseases, regulate patients’ behavior in order to promote their treatment efficacy and enhance patients’ treatment compliance and life quality11. The mode always puts patients under the limelight in clinical work and plays a highly important role in improving medical quality as well as patients’ satisfaction on condition that patients’ medical safety is guaranteed12. The application of the team’s management on patients with chronic diseases has showed that patients’ negative sentiments, life quality can be effectively improved13, and transfer treatment and continual care can also be improved14. Consequently, we introduced the mode into the management of MDR-TB patients, which turned out that these patients benefited a lot from the mode: their treatment compliance, completion rate and life quality were considerably promoted.
Multi-disciplinary cooperative complete management mode presents a new care management mode, which has achieved great application effect overseas. However, there are few domestic researches about this mode15. Compared with the conventional nursing pattern of tuberculosis, this mode has the following characteristics: ① Stage: In terms of in-hospital and out-hospital, patients can be ensured to take medicine on a regular basis and complete the designated treatment course on time; ② Continuity: The whole nursing process is carried out by the management group which is established upon admission. The seamless connection makes the nursing care service continual and effective and decreases the potential information leakage; ③ Richness: The establishment of personal files, drug use instructions, regular assessment, health education and so on are added based on nursing care in the mode; ④ Diversity of forms: The forms of follow-up include various ways, such as phone calls, home visits and out-patient clinic follow-up. Multi-media, health booklets and bedside education are contained in health education. Sending texts, telephone enquiry and on-site supervision are applied to supervise patients taking medicine. The researches by Cao Maotao16, Luo Shizhen17 and Zhang Huayan18 revealed that multi-disciplinary cooperative complete management mode can effectively regulate MDR-TB patients’ treatment habits, improve patients’ health knowledge level and medication compliance in order to further facilitate the improvement of prognosis, which produces a noticeable curative effect and deserves clinical application and expansion.
Multi-disciplinary cooperative complete management mode is a new model in which multi-disciplinary cooperation and complete management mode are effectively integrated together. Many professional medical staff in the team have complementary backgrounds and skills, and they are encouraged to involve in a dynamic process of collaborating and communicating with each other. In this way, multiple guarantee can be ensured and team members can better meet patients’ multi-faceted needs in a more effective, professional and comprehensive manner19. In this study, the multi-disciplinary mode could avoid the singleness and poor pertinency of the traditional one and effectively combine the merits of both the new mode and the traditional one so as to optimize its advantages. The application of multi-disciplinary cooperative complete management mode in the management of MDR-TB patients provides an interactive platform in which doctors and patients, patients and main caregivers can communicate with each other. Professional nursing care was provided throughout the whole process of treatment, and disease-related knowledge which patients failed to grasp after discharge, and the knowledge of infection control, health education and self-regulation were provided in particular for the purpose of helping patients get continuous, seamless and professional treatment and care, which ultimately aimed to control disease, improve the curative effect as well as life quality.
The establishment of the systematic and coherent procedures of multi-disciplinary cooperative complete management mode has resulted in a practical and workable implementation plan and patient-centered approach. The application of multi-disciplinary collaborative intervention in MDR-TB patients is beneficial to patients’ recovery and is worthy of clinical promotion and application. Admittedly, the application of the mode in the management of MDR-TB patients is only a preliminary study. As medical staff with multiple professional backgrounds are required in the mode, which is fairly complicated and needs considerable economic investment. Thus, policy-wise top-level design and a wider, deeper and multi-center study are in urgent need.