个体经营药店参与结核病控制的阻碍因素:定性抽样调查分析

Potential barriers to the involvement of private pharmacies in tuberculosis control: Qualitative investigation with sampling

目的:分析阻碍个体经营药店参与结核病控制的潜在因素。方法:实验于2005-07在重庆市区完成。调查主要采用了定性的方法,共调查了29名对象,采用方便抽样和滚雪球抽样的方法对15家经营时间1年以上的个体经营药店的管理人员或者工作人员进行了个人深入访谈;采用目的性抽样的方法对4名卫生监督所,药监局以及结核病防治所的相关官员及领导进行了关键人物访谈;采用专题小组访谈的形式,对2家结防专业机构的10名医护人员进行访谈。采用定性方法对采访对象进行了个人深入访谈、小组访谈、关键人物访谈。借助MAXqda软件,采用主体框架法进行分析。主要调查内容:①药店参与结核控制的现状,包括宣传结核病知识,发现、转诊结核病例。②药店参与结核病例发现的能力,包括员工的专业背景知识,对结核病知识的了解,接受新知识的机会。③药店参与结核病控制的客观阻碍因素,包括利益冲突、消费者的态度等。结果:29名受访对象均进入结果分析。①药店是患者接受健康教育的一个潜在的、重要的部门,绝大部分顾客在购药时都会咨询药店工作人员的意见,药店在发现以及转诊结核病患者中也起到一定促进作用,药店工作人员曾有发现结核病疑似患者并建议其接受医生治疗的经历。②药店从业人员仅了解部分结核病基础知识,缺少对结核病相关知识的知晓。但部分员工有医学或护理方面的专业背景,并且接受新知识的渠道也较多,如定期职能部门培训、电视以及报纸宣传等,但结核病知识的专题培训却相当少。③虽然绝大多数药店从业人员都认为推荐患者去结防所治疗不会对药店生意造成太大的影响,但也有部分人认为利益冲突会间接影响到药店参与结核病控制的行为。结论:药店在结核病控制工作中起到一定促进作用,但药店从业人员对结核病相关知识的了解有必要加强,采取一系列可行性措施解除这些阻碍因素,利益冲突会间接影响到药店参与结核病控制的行为。

AIM： To analyze the potential barriers to the involvement of private pharmacies in tuberculosis （TB） control. METHODS： The experiment was carried out in Chongqing in July 2005. Totally 29 subjected were investigated by qualitative methods. Convenience sampling and Snowball sampling were used in individual deep interviews of the owners or employees of 15 pharmacies that had been running for over 1 year. Purposive sampling was used in the key informant interviews, which were hold with 4 leaders from Drug Administration, TB Prevention Institute and the Ministry of Health Surveillance. Focus discussions were held with 10 staffs in 2 TB Dispensaries. With the MAXqda software, the data were analyzed by thematic framework method. The main contents included （1）present situation of the involvement of private pharmacies in TB control involving the dissemination of TB knowledge, TB detection and transfer treatment; （2） ability of private pharmacies in detecting TB cases including the background knowledge of staff, understanding to TB, and opportunity to received new knowledge; （3）objective barriers to the involvement of private pharmacies in TB control including profit conflict and attitudes of consumers. RESULTS： Twenty-nine interviewees all entered the result analysis. （1）Pharmacy is an important department for patients to received healthy education; most of the patient would seek advice from the staff working there when buying medicine. Pharmacy also could promote the discovery and transfer treatment of TB. There are staffs that advise the patient with suspected TB to treat in hospital. （2）Pharmacy staffs might have limited knowledge to TB diagnosis and treatment, but part of them have relative background educations and many chances to get new knowledge such as to received training in functional sections regularly, publication in TV and newspaper, but there are few special training about TB. （3）Most medical doctors doubted the profit dilemma would influence the staffs＇ behaviors in TB control, though some do not think so. CONCLUSION： Pharmacies have some promotion in TB control, but TB relative knowledge of staffs in pharmacies should be strengthened and a series of measures should also be carried out to settle those problems. Additionally, profit dilemma would influence the staffs＇ behaviors in TB control indirectly.