Co-morbidity of Tuberculosis with Mood Disorder: Prevalence, Risk Factors, Incentives Effect and Tuberculosis Treatment Outcomes in Taiwan

Tuberculosis;Mood Disorder;Pay-for-Performance;Healthcare Leadership & Management

Lu, An-ChiNolan, Marie ;

Johns Hopkins University

关键词: Tuberculosis;    Mood Disorder;    Pay-for-Performance;    Healthcare Leadership & Management;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/60566/LU-DISSERTATION-2015.pdf?sequence=1&isAllowed=n

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

ABSTRACTBackground: Tuberculosis (TB) is a leading cause of death from an infectious disease throughout the world. The incidence rate of TB in Taiwan remains higher than that of most developed countries. Mood disorders may have an important impact on the adherence to TB treatment. Taiwan’s government provided pay-for performance for TB programs (P4P) as an incentive; however, the impact of psychological factors on TB treatment is rarely recognized and studied. The aims of this study are 1) to investigate the prevalence and epidemiology of mood disorder, and examine patients;; demographic characteristics and their associations among TB patients; 2) to evaluate the impact of mood disorder on TB treatment default and TB patients’ mortality; and 3) to examine the impact of P4P effect on TB treatment default and TB patients’ mortality.Methods: The secondary health insurance dataset from Taiwan National Health Insurance Research Database (NHIRD) and Taiwan CDC TB Register data were used for this study. The study population consists of all newly diagnosed TB patients from 2002 to December 2007 in Taiwan. Outcome measures include mood status, TB treatment default rate and mortality. We used Chi-square and multivariate regression to analyze the relationship between mood status, risk factors, P4P effect and TB treatment default. The Cox proportional hazards regression models was used to identify factors associated with death. Kaplan–Meier method was used to evaluate mood disorder and P4P program impact on patient survival.Results: The prevalence of mood disorder among TB patients was 26.75 % in Taiwan, this was two times higher than in the general population (12.6%). Anxiety was the leading emotional problem (83.4%). TB patients who were elderly, females, and had higher income, disability, and high Charlson comorbidity index score (CCI) had a significantly higher chance of having a mood disorder. Risk factors for patients in the default group were having a mood disorder and being female. Regional level hospitals and family medicine specialties had the highest default rate (see glossary) Patients with mood disorders, were elderly, male, of lower income, disabled, and with high CCI had significantly higher risk of increased mortality. P4P in TB programs can decrease the default rate but had no significant influence on all-cause mortality.Conclusions: Our findings indicated that TB patients had a higher prevalence of mood disorders than in general population. Mood disorder posed as a barrier in TB treatment adherence. TB patients with mood disorder had significantly higher mortality and lower survival rates. P4P in TB programs was an effective incentive for decreasing default but no significant influence on all-cause mortality.