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目的探讨医疗单位向结防机构转诊的结核病人归口管理方法,提高病人发现率,规范病人治疗管理。方法结合湖南省实际,制订切实可行的结核病人归口管理实施办法与措施;对邵阳、常德和怀化3市实施《湖南省结核病人归口管理工作规范》(简称《规范》)前后,结核病人归口管理实施结果进行对照分析。结果实施《规范》前3市共接诊初诊病人29 953例,实施《规范》后为51 468例,后者较前者增长了71.8%。在初诊病人中,直接到结核病防治机构就诊者增加13 056例,增长了51.0%,医疗单位转诊者增加21 515例,增长194.0%。实施《规范》前,3市共发现新涂阳病人5 201例,实施《规范》后为10 596例,前后比较增长了103.7%。在新涂阳病人中,直接到结防机构就诊者较实施《规范》前增加1 944例,增长了47.3%,医疗单位转诊者增加3 451例,增长315.2%。在转诊病人中,县级医疗单位和乡级医疗单位比实施《规范》前分别增加1 932和1 385例,分别增长了337.8%和324.4%。同期全省实施《规范》地区和未实施《规范》地区新涂阳病人登记率分别58.47/10万和30.13/10万,前者比后者高94.4%。结论《湖南省结核病人归口管理工作规范》的实施方法与措施是可行的结核病人归口管理办法;做好结核病归口管理是提高病人发现率的有效方法。
Objective To explore the centralized management of tuberculosis patients referral to TB units by medical units, improve the detection rate of patients and standardize the management of patients. Methods Combining with the actual situation of Hunan Province, formulating practicable methods and measures for the centralized management of tuberculosis patients; before and after the implementation of the “Hunan Province Tuberculosis Patient Management Regulations” (referred to as “Code”) in Shaoyang, Changde and Huaihua City, the tuberculosis patients were managed The results of the implementation of comparative analysis. Results A total of 29 953 newly diagnosed patients were enrolled in the first three cities before the implementation of the “Code”, 51 468 cases after implementation of the “Code”, and the latter increased 71.8% over the former. Among newly diagnosed patients, 13,056 cases went directly to tuberculosis prevention and treatment organizations, an increase of 51.0%; 21,515 cases of referral to medical units increased by 194.0%. Before the implementation of the “Code”, 5,201 new smear positive patients were found in 3 cities, 10,596 after the implementation of the “Code”, an increase of 103.7% before and after the implementation. Among newly smear-positive patients, the number of patients directly attending tuberculosis prevention institutions increased by 1 944 cases or 47.3% before the implementation of the Code, and the number of referrals for medical units increased by 3 451 cases, an increase of 315.2%. Among referral patients, the number of county-level medical units and township-level medical units increased by 1,932 and 1,355 respectively before the implementation of the Code, an increase of 337.8% and 324.4% respectively. In the same period, the registration rates of new smear-positive patients in the “normative” areas and in the “normative” areas were 58.47 / 100000 and 30.13 / 100000, respectively, the former being 94.4% higher than the latter. Conclusions The implementation methods and measures of “Hunan Province Tuberculosis Patients centralized management norms” is a viable management approach for tuberculosis patients; management of tuberculosis centralized management is an effective way to improve the detection rate of patients.