山东省苍山县结核患者发现方式分析

Analysis of mode of tuberculosis case-finding in Cangshan County of Shandong province

目的描述分析山东省苍山县结核患者的发现方式,探索提高结核患者发现水平的方法。方法选取2003—2007年苍山县传染病网络直报资料以及结核病初诊患者登记资料,并进行统计分析。结果患者直接到结核病防治机构就诊方式发现的病例数最多,为1 434(45.5%)例,其次是转诊1 326(42.1%)例、日常推荐250(7.9%)例、追踪到位83(2.6%)例以及集中推荐58(1.8%)例;转诊的患者中确诊为结核患者的构成比最大,为54.8%。直接就诊的患者中确诊为结核的患者占11.4%。集中推荐的患者中确诊的结核患者构成比最低,只有1.8%;县级医疗机构是推荐疑似病例的主要来源。结论绝大多数结核病患者的发现来自于医疗机构的转诊和推荐,另外一个患者主要来源是主动就诊。因此,加强三级防痨网的建设,强化医务人员的转诊推荐意识;加强大众健康教育,提高疑似病例主动就诊是提高结核病患者发现的关键方式。

Objective To describe mode of tuberculosis case-finding in Cangshan county of Shandong province and explore methods to improve tuberculosis case-finding. Methods The data of tuberculosis reporting during 2003—2007 in Cangshan county were obtained from the National Internet-based Reporting System of Notifiable Infectious Disease.Information of TB register of Cangshan tuberculosis Dispensary was also collected.χ2 test was applied in the data analysis. Results Of tuberculosis patients registered in Cangshan county,1 434（45.5%） directly visited tuberculosis dispensary,while 1 326（42.1%）,250（7.9%）,83（2.6%）and 58（1.8%） were detected by referral,routine recommendation,tracing and concentrated recommendation respectively.The proportion of tuberculosis suspects diagnosed as tuberculosis patients varied between different ways： for referral patients,the proportion was the greatest 54.8%;of the patients directly visiting TB dispensary,11.4% were diagnosed as TB;only 1.8% of tuberculosis suspects visiting TB dispensary through concentrated recommendation were diagnosed as TB,which was the least.County-level health facilities were the main source of suspected TB patients referred to TB Dispensary. Conclusions Most tuberculosis patients were detected through referral and lower level recommendation.Another important source is patient＇ self-visit.Future work should focus on to strengthen the construction of three level tuberculosis control network,and strengthen the awareness of referral and recommendation by medical staff;to strengthen public health education and improve potential of actively seeking medical treatment by suspected cases;Take the initiative to carry out screening in selected high-risk populations.