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目的分析新发涂阳肺结核病患者首次就诊医疗机构情况,探讨涂阳肺结核病患者首次就诊医疗机构对结核病发现工作的影响。方法采用非概率抽样,选择湖南省郴州市桂阳、宜章、永新、北湖区共4县(区)为调查现场,利用调查表,前瞻性收集2007年4月中旬至10月中旬就诊的新发涂阳肺结核患者基本情况,首发症状,首诊医疗机构及就诊后的首次检查等信息。结果共收集186例新发涂阳患者的资料。首次选择到非结核病防治机构就诊者占97.8%(182/186);首诊选择在药店、个体诊所的患者有22人(占35.5%)需≥3次才被确诊为结核;患者因“离家近方便”而选择相应医疗机构的比例为58.6%(109/186);县级及以上综合医院的转诊率为67.1%(47/70),村医务室、乡镇卫生院和乡中心卫生院的日常推荐率为26.5%(13/49);首次就诊没进行任何检查的比例为50.5%(94/186);县级及以上综合医院的痰检率为2.9%(2/68);结核病相关知识不知晓率为47.3%(88/186)。结论首诊选择非结核病专业防治机构的患者比例较高;村医务室、乡镇卫生院和乡中心卫生院的日常推荐率相对较低;综合医院痰检率非常低。因而,首先要有针对性地加大结核病相关知识的宣传力度,提高患者主动就诊结核病防治机构的比例,才能及时发现患者;其次,可考虑进一步完善结核病防治体系,如药店和个体诊所纳入到体系中;健全卫生行政部门主导下的业务培训体系等,来增加结核病的发现力度。
OBJECTIVE: To analyze the first visit of medical institutions in new smear-positive pulmonary tuberculosis patients and explore the impact of first-visit medical institutions on the detection of tuberculosis in smear-positive pulmonary tuberculosis patients. Methods A total of 4 counties (districts) in Guiyang, Yizhang, Yongxin and Beihu districts of Chenzhou City in Hunan Province were selected as non-probable sampling sites. A questionnaire was used to prospectively collect information from mid-April 2007 to mid-October 2007 New smear-positive pulmonary tuberculosis patients basic information, first symptom, the first visit to medical institutions and the first check after treatment and other information. Results A total of 186 cases of smear-positive patients were collected. For the first time, 97.8% (182/186) of the patients were selected to go to non-TB treatment institutions; 22 (35.5%) were selected as first-choice patients in pharmacies or individual clinics and were diagnosed with TB≥3 times; (59.6%). The referral rate was 67.1% (47/70) in the general hospitals at the county level and above. The village clinic, township hospitals and townships The daily referral rate of central hospitals was 26.5% (13/49). No initial check-up was conducted for 50.5% (94/186) of patients; the sputum sampling rate was 2.9% (2/68) in general hospitals at county level and above ). The unknown rate of tuberculosis-related knowledge was 47.3% (88/186). Conclusion The proportion of first responders who choose non-tuberculosis prevention and treatment institutions is relatively high. The daily referral rates of village clinics, township hospitals and township hospitals are relatively low. The sputum sampling rate in general hospitals is very low. Therefore, we must first increase awareness of tuberculosis-related publicity efforts to increase the proportion of patients active treatment of tuberculosis prevention agencies in order to timely detection of patients; Second, we can consider further improvement of tuberculosis prevention and control system, such as pharmacies and individual clinics into the system In the health administration department under the guidance of the business training system, etc., to increase the detection of tuberculosis.