广东省不同结核病防治体系模式的工作成效分析

Analysis on the effectiveness of different tuberculosis prevention and control system models in Guangdong Province

目的探索广东省不同结核病防控体系模式的工作成效并进行分析。方法对广东省肺结核监测报表中的2017年指标数据,2017年广东省统计局公布的各地市国内生产总值(GDP).以及2017年度广东省各地市工作总结、省督导地市的报告和广东省结核病防治体系模式调研报告、史志材料进行综合分析。对不同政府投入下相同防治体系(防治结合的医院模式)及相同政府投入下不同体系(防治结合的医院模式与防治结合的门诊模式,防治结合与防治分开模式)的工作成效进行综合评价。结果2017年广东省各地方政府结核病防治投入在131.68万元,3614.90万元之间;政府投入的总效益在5811.39万元?277763.65万元之间。(1)不同政府投入下相同防治体系(防治结合的医院模式)工作成效对照(深圳市和汕头市):深圳市和汕头市人均政府投人分别为3.04元和1.41元;政府投入的总效益深圳市(134720.89万元)高于汕头市(27827.61万元);深圳市报告发病率(55.3/10万)低于汕头市(117.8/10万);深圳市登记率(45.9/10万)接近报告发病率(55.3/10万),汕头市登记率(47.6,10万)与报告发病率(117.8/10万)差距大。(2)相近政府投入下不同防治体系的工作成效对照:①防治结合的医院模式(佛山市)与防治结合的门诊模式(珠海市)成效对照:佛山市和珠海市人均政府投入分别为1.89元和1.83元;政府投入的总效益佛山市(9897&06万元)高于珠海市(36894.81万元);佛山市转诊到位率和成功治疗率分别93.4%和9』.8%;珠海市转诊到位率和成功治疗率均为95.8%,两市接近;佛山市报告发病率(49.0/10万)和登记率(49.0/10万)差距较小;珠海市报告发病率为71.3/10万.登记率为74.6/10万.两者差距较大。②防治分开模式(潮州市)和防治结合的医院模式(茂名市)成效对照:潮州市和茂名市人均政府投入分别为0.50元和0.48元;茂名市政府投入的总效益(33723.26万元)高于潮州市(5811.39万元);潮州市报告发病率(68.5/10万)高于茂名市(61.5/10万);潮州市登记率(27.7/10万)低于茂名市(53.8/10万)。结论政府投入水平对结核病防治体系的工作成效影响较大;在相同的政府投入水平下.防治结合的模式优于防治分开模式(“三位一体”模式);防治结合的医院模式优于防治结合的门诊模式。

Objective To explore and analyze the effectiveness of different tuberculosis prevention and control system models in Guangdong Province. Methods The 2017 indicator data in the Guangdong Provincial Tuberculosis Monitoring Report,the gross domestic product of the cities and towns reported by the Guangdong Provincial Bureau Statistics in 2017. and the work summary of the cities in Guangdong Province, the report of the provincial supervision city and the research report on the models of tuberculosis prevention and control system model in Guangdong Province in 2017, as well as historical record were comprehensively analyzed. The effectiveness of same model under different local government inputs (combination of prevention and control at hospital level) and different models under the same government input (combination of prevention and control at hospital versus outpatient level, and combination versus separation of prevention and control) were evaluated. Results In 2017, the local governments of Guangdong Province invested 1 316 800 to 36 149 000 yuan, and the total benefit of the government investment was between 58 113 900 and 2 777 636 500 yuan.(1) Comparison in effectiveness of same model under different local gover nments in puts (combination of prevention and control at hospital level) between Shenzhen and Shantou City: the per capita government investment was 3. 04 yuan in Shenzhen and 1. 41 yuan in Shantou, respecdoi tivelv;the total benefit of government investment in Shenzhcn (1 347 208 900 yuan) was higher than that in Shantou (278 276 100 yuan);the reported incidence rate in Shenzhen (55. 3/100 000) was lower than that in Shantou (117. 8/100 000);the registration rate (45. 9/100 000) was close to the reported incidence rate in Shenzhen, whereas the registration rate (47. 6/100 000) was far from the reported incidence rate in Shantou.(2) Comparison in different models under the same governments inputs:① combi nation of prevention and control at hospital level (Foshan City) versus combination of prevention and control at outpatient level ( Zhuhai City): the per capita government investment was 1. 89 yuan in Foshan and 1. 83 yuan in Zhuhai: the total benefit of the government investment in Foshan (989 780 600 yuan) was higher than that in Zhuhai (368 948 100 yuan);the referral rate and successful treatment rate were 93. 4% and 94. 8% in Foshan, which were close to those in Zhuhai (both were 95. 8%);the incidence rate (48. 9/100 000) and the registration rate (49. 0, 100 000) in Foshan was similar;the reported incidence rate in Zhuhai was 71. 3/100 000, and the registration rate was 74. 6! 100 000, and the difference between the two indicators was larger.② Separation of prevention ancl control (Chaozhou City) versus combination of prevention and control (Maoming City): the per capita government investment was 0. 50 yuan in Chaozhou and 0. 48 yuan in Maoming;total benefit invested by the Maoming Municipal Government (337 232 600 yuan) was higher than that of Chaozhou Municipal Government (58 113 900 yuan);the reported incidence rate in Chaozhou (68. 5/100 000) was higher than that in Maoming (61. 5/100 000);the registration rate in Chaozhou (27. 7/100 000) was lower than that on Maoming (53. 8/100 000). Conclusion The level of government input has a great impact on the effectiveness of the tuberculosis prevention and control system. Under the same government input, the combination of prevention and control model is better than the separation model (“Trinity" model). and combination at the hospital level is better than that at the outpatient level.