综合医院与结核病防治机构合作提高肺结核患者发现率的研究

Increasing Case Detection through the Collaboration between Hospital and TB Dispensary

目的探索提高肺结核患者发现率的新途径,加快患者发现进程,实现世界卫生组织(WHO)提出的全球结核病控制阶段性目标。方法选择湖北省2002年度涂阳肺结核登记率低于全省平均水平的40个县,在每个县选择1家门诊量最大的综合医院和结核病防治中心作为研究项目实施单位。通过对综合医院相关科室医务人员进行培训和督导,从而在综合医院建立肺结核可疑症状者诊断、疫情报告和转诊工作规范。利用月报和季度报表收集资料,采用χ2检验对率和构成比进行统计分析,处理过程通过SAS 8.1实现。结果2003年10月至2004年9月期间,40个县累计发现新涂阳肺结核患者12 193例,比项目实施前同期增加了3 965例;新涂阳患者登记率由项目前同期的33.6/10万提高到49.6/10万(χ2=760.8,P<0.01),患者发现率由57.8%提高到85.5%。40个县综合医院门诊对肺结核可疑症状者查痰率达到48.6%,涂阳检出率为15.6%,患者转诊率为29.7%。医院门诊登记的11 303例可疑症状者中,共查出涂阳肺结核患者1 663例,占40个县涂阳患者发现总数的11.2%。结论加强综合医院与结核病防治中心的协调与合作,特别是加强医院肺结核患者和肺结核可疑症状者的转诊和追踪调查,能够快速地提高新涂阳肺结核患者发现水平。

Objective To explore the new approach to increase case detection of pulmonary tuberculosis （TB） and to realize the targets declared by WHO. Methods One TB dispensary and one general hospital in each county among 40 counties whose case detection rates were lower than the average in Hubei province in 2002 were enrolled in this project. Health care workers in hospital were trained by TB staff and standard work procedures including case check, diagnosis, registration, notification, and referral were established in both TB dispensary and hospital. Monthly and quarterly reports were collected and checked regularly. X^2 test was applied to analyze the data by SAS 8.1. Results From Oct. 2003 to Sept. 2004, 12 193 new TB cases which were smear positive were detected in 40 counties, which was the 1.5 times of the cases detected during the same period before the project was carried out. The new smear positive registration rate was increased from 33.6 per 100 000 to 49.6 per 100 000 （X^2 =760.8, P〈0.01） and the case detection rate increased from 57.8% to 85.5%. The sputum examination in general hospital was performed in 48.6% of the clinical suspects. From the suspects, in which the sputum smear microscopy was done, the smear positive rate was 15.6%. 29.7% of TB patients diagnosed in hospital were transferred to TB dispensary. Total 1 663 smear positive TB cases were detected by both hospital and TB dispensary among 11 303 suspects registered in hospital, which accounted for 11.2 % of the total cases of 14 914. Conclusion It may obviously improve the case detection to strengthen the coordination and cooperation between general hospital and TB dispensary, especially for the referral and follow-up of TB patients and suspects.