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目的:探索提高结核病人发现的新方法。方法:30个区/县参与本研究。经过培训的村医对结核病可疑症状者进行调查并转诊至县结防所,定点乡镇卫生院或综合医院进行免费痰涂片检查。综合医院报告的结核病病人和可疑者如在转诊过程中丢失,由县级结防人员进行追踪。结果:共发现12 091例新涂阳肺结核病人。新涂阳肺结核病人登记率由项目前的36.2/10万提高至项目后的49.9/10万,DOTS策略下的病人发现率达到86%。登记的43 464例结核病可疑者中, 15363(35.3%)例是由村医和综合医院医生转诊的。转诊率明显上升(P<0.01)。在转诊的15 363例病人中,3 870例被诊断为新涂阳肺结核病人。在3类不同的显微镜痰涂片检查中心,其结核病可疑者的痰检率和涂阳检出率明显不同,具有统计学意义。追踪率为70.9%,但追踪到位率只有33.1%。结论:加强村医转诊结核病可疑者到县结防所,是提高病人发现率的有效途径。同时对病人和村医进行转诊激励也十分必要。
Objective: To explore new ways to improve the detection of TB patients. Methods: 30 districts / counties involved in this study. Trained village doctors survey suspicious symptoms of tuberculosis and referral to the county Jie Fang, designated township hospitals or general hospitals for free sputum smear. TB patients and suspects reported by general hospitals will be followed up by county-level defensive and inundation personnel if they are lost during referral. Results: A total of 12 091 new smear-positive pulmonary tuberculosis patients were found. The registration rate of new smear-positive pulmonary tuberculosis patients increased from 36.2 / 100,000 before the project to 49.9 / 100,000 after the project, and the patient discovery rate under the DOTS strategy reached 86%. Among the 43 464 suspicious TB cases registered, 15 363 (35.3%) were referred by village doctors and general practitioners. The referral rate increased significantly (P <0.01). Of the 15,363 referrals, 3,870 were diagnosed as having new smear-positive tuberculosis. In three different types of microscopy sputum smear test center, the tuberculosis suspicious sputum examination rate and smear positive rate was significantly different, with statistical significance. The tracking rate was 70.9%, but the tracking rate was only 33.1%. Conclusion: Strengthening TB referrals to village clinics is an effective way to improve the detection rate of patients. It is also necessary to refer patients and village doctors for referral.