通过建立激励机制提高肺结核患者发现和治疗效果的研究

Study on improving tuberculosis case detection and treatment through establishing incentive mechanism

目的探讨激励机制对提高肺结核患者发现和治疗效果的作用,为制定结核病控制策略提供科学依据。方法FIDELIS项目于2004年11月至2005年10月在山西省50个县实施,主要措施是向贫困患者和卫生服务人员提供激励机制。结果项目地区新涂阳患者登记数在项目实施前为5105例,项目实施后为7736例,项目实施后患者数是项目前的151.5%(P<0.01)。项目实施前后,治疗2个月末痰菌阴转率分别为95.5%和96.0%,患者治愈率分别为93.4%和95.2%。结论在山西省的50个县采取的激励机制是十分有效的,符合投入-效益原则。

Objective To establish incentive mechanism for improving TB case detection while maintain high cure rate, and to provide evidence for making TB control policy. Methods The FIDELIS project was implemented from Nov. 2004 to Oct. 2005 in 50 counties of Shanxi Province, with the main intervention of providing incentive mechanism to poor TB patients and health service providers. Results The number of new smear positive TB cases significantly increased from 5105 to 7736 （P〈0.01）. The sputum conversion rate before and after treatment were 95.5% and 96.0% respectively. The cure rate were 93.4% and 95.2%. Conclusion The incentive mechanism established in Shanxi FIDELIS project included providing transportation fee to poor patients upon their visit to TB dispensary for TB diagnosis, providing incentive for doctors who referred a new smear positive patient to TB dispensary, for village doctors on directly observing the six month treatment of a new smear positive patient. The results indicated the incentive mechanism was effective and cost-benefit.