结防机构与医院合作提高肺结核病患者发现研究

Cooperation Between TB Control Dispensary and General Hospitals to Improve Detection of TB Cases in Shandong Province

目的实施加强肺结核病患者报告、转诊及追踪为重点以提高患者发现的综合措施,对其可行性、可操作性及对患者发现影响进行评价。方法在现代结核病控制策略(DOTS)实施质量较好的5个县(区),通过结防机构与医院合作,实施6个月以加强肺结核病患者报告、转诊及追踪为重点的提高患者发现综合措施,收集干预前同期以及干预期间有关定性及定量信息,进行比较、分析。结果干预后各县建立、完善了结防机构与医院合作机制,肺结核病患者报告、转诊、追踪程序得以规范和完善。干预前后目标医院报告率、转诊率、到位率分别是39.3%、98.6%;91.2%、96.7%;62.8%、72.9%,差异有统计学意义。网络直报系统报告的应转诊患者总体到位率为82.9%。6个月干预期间目标医院转诊到结防机构的肺结核病患者数是干预前同期的1.3倍。结论以加强患者报告、转诊以及追踪为重点的提高患者发现的综合措施是可行的;明显提高了肺结核病患者发现水平。

Objective To terventions on reporting, appraise the feasibility of the inreferring and tracing of patients with tuberculosis and to determine the impact of such interventions on case finding in a pilot area. Methods Perspective study was carried out in 5 counties （districts） with acceptable DOTS implementation quality. A package of interventions focused on improving reporting, referring and tracing patients with tuberculosis through the cooperation between hospitals and tuberculosis dispensaries were implemented in the pilot area for 6 months. The qualitative and quantitative data collected from the same period of previous year of the pilot and from the duration of the pilot were compared and analyzed. Results Compared with the previous year of the pilot, the mechanism of cooperation between hospitals and tuberculosis dispensaries was established and improved, and the standardized working procedures on reporting, referring within hospitals and tracing from tuberculosis dispensaries were implemented and improved. After intervention, the reporting rate, referred rate and referred arrival rate of target hospitals increased from 39.3% to 98.6%, 91.2% to 96. 7%, and 62. 8% to 72.9%, respectively. The differences after and before intervention of the three rates were statistically significant. The overall arrival rate of the reported patients from the Internet Based Communicable Diseases Reporting System that should be referred was 82. 9%. The overall impact results showed that among registered patients with tuberculosis in tuberculosis dispensaries, the humber of confirmed TB patients from target hospitals was 1.3 times of that before the intervention, which contributed to the overall patients finding in the pilot area. Conclusions The package of approaches to strengthen the cooperation between hospitals and tuberculosis dispensaries focused on improving reporting, referring and tracing are feasible. Case finding increased significantly through the related interventions. The experiences and some key parameters can be applied in the planning process of PPM-DOTS expansion.