全国肺结核病人的转诊对涂阳病人登记率的影响

Impact of referral system on the registration rate of smear positive pulmonary tuberculosis patients in China

目的分析2002～2004年全国医疗机构肺结核病人转诊对涂阳病人登记率的影响。方法对2002年1季度至2004年3季度全国31省(直辖市、自治区)不同来源初诊病人中发现的涂阳病人构成比进行统计分析,对转诊发现的涂阳病人登记率与总涂阳病人登记率进行相关回归分析。结果全国不同来源初诊病人中发现的涂阳病人构成比,以因症就诊为第一位,占57.5%,其次为转诊占32.9%,集中推荐、日常推荐等占9.6%。2002～2004年全国各年度转诊发现的涂阳病人构成比中,2004年为35.2%,高于前两年。在全国31个省(直辖市、自治区)中,5个省由转诊发现的涂阳病人占总涂阳病人的50.0%以上,两个省在40.0%以上,8个省在30.0%以上,13个省在20.0%以上,3个省在20.0%以下。对转诊发现的涂阳病人登记率和总涂阳病人登记率建立回归方程,对回归系数进行显著性检验F=86.31,P<0.01。通过制定散点图,由于出现一个异常点,剔出后制定修订回归方程Y=2.0917X+8.455,对回归系数进行显著性检验,F=131.46,P<0.01。结论加强肺结核病人的转诊是我国结核病控制工作中提高涂阳肺结核病人发现率的一个重要手段。由转诊发现涂阳肺结核病人已成为一些省发现肺结核病人的主要来源。由转诊发现涂阳病人登记率与总涂阳病人登记率呈正相关关系。

Objective To assess the impact of the referral system on the registration rate of smear positive (S+) pulmonary tuberculosis (PTB) patients. Methods The data of registered S+ PTB patients in the NTP Quarterly Report from the first quarter in 2002 to the third quarter in 2004 in 31 provinces / municipalities / autonomous regions in China were analyzed so as to understand the constituent ratio of S+ PTB in the first visit patients from different sources. A regression analysis was made to observe the correlation between the total registration rate of S+ PTB and the registration rate of referred S+ PTB. Results According to the analysis of the category of the registered S+ PTB patients in China, the PTB patients from consulting for symptoms ranked the first which accounts for 57.5% of the total S+ PTB patients; referred PTB patients was the second which occupies 32.9%; the third category was the focus and regular recommendation which accounted for 9.6% of the total. The proportion of referred S+ PTB patients in the total S+ PTB patients was 35.2% in 2004, higher than it was in 2002 and 2004. Among the 31 provinces / municipalities / autonomous regions in China, the proportion of referred S+ PTB patients in the total S+ PTB patients was over 50% in 5 provinces; over 40% in 2 provinces; over 30% in 8 provinces; over 20% in 13 provinces, and lower than 20% in 3 provinces. The analysis of the correlation between the total registration rate of S+ PTB and the registration rate of referred S+ PTB showed the association was statistically significant (F=86.31, P<0.01). The correction formula was Y=2.0917X+8.455 excluding the outlier. The significant test of the coefficient of correlation showed it was statistically significant (F=131.46, P<0.01). Conclusion To strengthen the referral system is a key method to increase the detection of S+ PTB patients in China. In half of the 31 provinces / municipalities / autonomous regions, referral has become the main source of S+ PTB patients. Referral rate and registration rate of S+ PTB patients are positively correlated.