江苏省扬中市社区慢性咳嗽患者结核病医疗服务可及性及其影响因素研究

Access to tuberculosis care among community patients with chronic cough in Yangzhong County,Jiangsu Province

目的探讨慢性咳嗽满3周的潜在结核病患者结核病医疗服务可及性及其社会经济和人口学影响因素.方法以非直接督导下的短程治疗策略（Directly observed treatment shorr-course,DOTS）结核病控制项目地区的江苏省扬中市为现场,通过随机整群抽样,对从20个村33549名14岁以上常住居民中识别的171例持续咳嗽和/或咳痰满3周的潜在结核病患者进行问卷调查和胸透及痰涂片检查.结果33%的对象从未就诊,其估计的就诊延误中位数为67（51～93）天,远大于已就诊者的首诊延误10（4～31）天和正式就诊延误中位数15（5～31）天（P=0.000）.无医疗保险者就诊及正式就诊的可能性仅为有医疗保险者的42.2%,且发生就诊延误和正式就诊延误的可能性较高;男性就诊的可能性比女性小;农民及距离医疗机构较远者就诊延误的可能性大.结论非结核病控制项目地区慢性咳嗽患者结核病医疗可及性较弱,有可能影响结核病的人群发现率,不健全的医疗保险制度是其重要的制约因素.

Objective To describe the access to tuberculosis care among patients with long-term chronic cough （potential TB cases）, and to study the impact of socio-economic and demographic factors on the access. Methods Randomized cluster sampling was used to select 20 villages as the study sites from 94 villages in a county where modern TB control program with DOTS has not been established -Yangzhong in Jiangsu Province, China. 171 patients with chronic cough,identified from all residents （n = 33549） aged 〉 14 years were interviewed using a structured questionnaire. Fluoroscopy and sputum smear were used for diagnosis. Results The median delay of patients （ n = 56） who did not seek any health care （quartile：51days-93days） was 67days,longer than the delay to first health care provider （ 10days, quartile ： 4days-31days） and patient＇s delay （15days, quartile ： 5-31days ） of those who had sought health care （P = 0.000）. Uninsured patients were 42.2% less likely to access health facility and general hospitals than insured patients; meanwhile, they had a longer delay to first health care provider and general hospital. Men were less likely to seek health care service in primary health care provider. Farmers had a longer delay to first health care provider, so did the patients whose houses were far from health facilities. Conclusion Potential TB patients with long-term cough in the non-program area of China have poor access to tuberculosis care,which could affect the detection of TB patients in population. Medical insurance is one of the most important factors to influence patients＇ access to TB care.