湖南省186例新发涂阳肺结核病患者首诊医疗机构情况分析

Analysis of the first medical care seeking of 186 new smear-positive pulmonary tuberculosis patients in Hunan province

目的分析新发涂阳肺结核病患者首次就诊医疗机构情况,探讨涂阳肺结核病患者首次就诊医疗机构对结核病发现工作的影响。方法采用非概率抽样,选择湖南省郴州市桂阳、宜章、永新、北湖区共4县(区)为调查现场,利用调查表,前瞻性收集2007年4月中旬至10月中旬就诊的新发涂阳肺结核患者基本情况,首发症状,首诊医疗机构及就诊后的首次检查等信息。结果共收集186例新发涂阳患者的资料。首次选择到非结核病防治机构就诊者占97.8%(182/186);首诊选择在药店、个体诊所的患者有22人(占35.5%)需≥3次才被确诊为结核;患者因"离家近方便"而选择相应医疗机构的比例为58.6%(109/186);县级及以上综合医院的转诊率为67.1%(47/70),村医务室、乡镇卫生院和乡中心卫生院的日常推荐率为26.5%(13/49);首次就诊没进行任何检查的比例为50.5%(94/186);县级及以上综合医院的痰检率为2.9%(2/68);结核病相关知识不知晓率为47.3%(88/186)。结论首诊选择非结核病专业防治机构的患者比例较高;村医务室、乡镇卫生院和乡中心卫生院的日常推荐率相对较低;综合医院痰检率非常低。因而,首先要有针对性地加大结核病相关知识的宣传力度,提高患者主动就诊结核病防治机构的比例,才能及时发现患者;其次,可考虑进一步完善结核病防治体系,如药店和个体诊所纳入到体系中;健全卫生行政部门主导下的业务培训体系等,来增加结核病的发现力度。

Objective The study was conducted to analyze the first medical care seeking of new smear-positive pulmonary TB patients and the impact on TB ease finding. Methods Non-probability sampling method were used to select Guiyang, Yizhang, Yongxin and Beihu districts in Chenzhou city, Hunan province as the survey sites, and questionnaires were used to collect the basic information, including initial symptoms, first-visiting medical agencies and the first test results of the new smear-positive pulmonary TB patients seeking medical care from mid April to mid October, 2007. Results A total of 186 new smear-positive patients were surveyed. The patients who first visited non-professional anti-TB agencies accounted for 97.8% and 22 patients were diagnosed as TB by visiting pharmacies and private clinics for 3 times or more. The patients who chose nearby medical agencies for convenience accounted for 58.6%. The referral rate was 67.1% in general hospitals above county level （47/70）. And the daily recommendation rate of village clinics/township health centers was 26.5% （13/49）. The patients who received no examination on their first visit accounted for 50.5% （94/186）; only 2.9% （2/68） of general hospitals above the county level tested the sputum samples. Non-awareness rate of TB-related knowledge was 47.3% （88/186）. Conclusion High proportion of patients went to see doctor in non-professional anti-TB agencies for the first medical care. Low referral rates were found in village clinics and township health centers, and low sputum test rates were found in genera] hospitals. Therefore, it is important to improve the health education about TB-related knowledge and encourage patients to seek medical care in professional anti-TB agencies for the timely discovery of TB cases. In addition, consideration shall be given to further improve the current anti-TB system, such as the inclusion of pharmacies and private clinics into the system and the provision of professional training under the guidance of health department to improve the detection of TB patients.