城市综合医疗机构对疑似肺结核病例诊断分析

Analysis of diagnosis of pulmonary tuberculosis suspects in urban general health facilities

目的探讨综合性医疗机构对肺结构病诊断延误的影响,为提高病人发现率提供参考。方法采用前瞻性队列研究与定性方法相结合,对在重庆市2个区选定的综合医疗机构就诊的结核疑似病人进行为期3个月的随访调查,并对医务人员和相关政策决策者进行个人深入访谈,以了解病人的就诊经历,分析卫生服务供方因素对结核病诊断的影响。结果49.2%的病人选择区级医院作为他们初次就诊单位;61.0%的病人被建议接受X光检查,19.1%的病人被建议进行痰检,仅4.9%的病人被建议转至结防所。定性研究支持定量的发现,医务人员对结核病控制策略了解甚少。结论综合医疗机构在结防控制工作中没有发挥应有的作用,结核控制策略在综合医疗单位中宣传不够,并缺乏与结防体系间的有效交流和合作。

Objective To explore the influence of delays of tuberculosis（TB） diagnosis in general health facilities in order to make recommendation to improve the case detection. Methods A prospective cohort study of adult TB suspects with more than 3 weeks cough was carried out over a period of 3 months in selected general health facilities to understand their health care seeking experiences. In - depth interviews with health providers and relevant policy makers were held to explore their knowledge and attitude on TB and the TB control programme and analyze related influence factors. Results 49.2 % of patients selected the district hospital as their first health service provider. 61.0% of respondents were sent for X- ray and 19.1% for sputum smear test and ordy 4.9% were referred to TB dispensary. Qualitative data supported the findings of quantitative study and showed general health staff had insufficient knowledge on TB and TB control programme. Conclusion The general health facilities have not played a satisfactory role in complementing the TB control programme. The strategies of TB control programme are not disseminated weU in the general health facilities and there is lack of the cooperation and communication between the TB control system and the general health system.