在职培训对医务人员结核病知识知晓率和患者发现率影响的调查

An Investigation on Infulence of In-service Training on Awareness of Tuberculosis Prevention and Detection in Health-care Workers

目的了解综合医院中医务人员结核病知识的掌握情况及培训对结核病病人发现的影响。方法对北京市综合性三级甲等医院1家、二级甲等医院1家、远郊区县级医院1家的医务人员进行结核病相关知识培训，期间抽取每家医院20人（共60人）在培训前后接受问卷调查。分别有2份问卷，结核病防治政策法规和结核病流行病学知识、结核病诊断和治疗问卷各1份。回收有效问卷120份。比较3所医院医技人员培训前后相关知识知晓率的变化。同时收集培训前1年和培训后1年的各医院结核病人诊断和报告情况。结果培训前参与调查者对结核病诊断和治疗具有一定的经验和水平，问卷平均得分64～80分，3家医院间得分的差异具有统计学意义（F=5984，P〈001），虽然培训后得分有提高，但与培训前比较差异无统计学意义（P〉0．05）。大部分医务人员对国家结核病防治政策法规和结核病流行病学知识存有欠缺，最低平均分只有383分，最高71．7分，培训后分数均有明显提高（P〈0．01）；培训前1年与培训后1年3家医院肺结核病报告情况自身比较，呼吸科X线摄片率三级甲等和二级甲等医院有明显下降（P〈0．01），肺结核报卡率、报卡痰检率前后差异均无统计学意义（P〉0.05）。结论综合医院医务人员对结核病诊断和治疗有一定能力和水平，但对国家结核病防治政策法规和流行病学知识欠缺；短期培训不能提高肺结核病的发现和报告数量。

Objective To investigate awareness about tuberculosis （TB） prevention and treatment and influence of professional training on TB detection among health-care workers （HCWs） in general hospitals. Methods In total, 350 HCWs were trained for TB-related knowledge for eight class-hours in a two-day course in three general hospitals, and 20 HCWs from each of the three hospitals classified as grade 3A and grade 2A in urban Beijing and grade B at suburban Beijing, respectively, were interviewed with questionnaire designed to understand their awareness about TB prevention policy, epidemiology, diagnosis and treatment, and to evaluate effectiveness of the training, respectively. All the trainees responded before and after the training, with a hundred percent of response rate. TB diagnosis and reporting one year before training in the three hospitals were compared to those one year after it. Results Scores of knowledge about TB diagnosis and treatment averaged 64-80 for HCWs before training, with statistically significant difference among three hospitals （F=5.984, P〈0.01）. Scores increased after training, but without significant difference from those before it （P〉0.05）. Awareness of TB prevention policy, regulations and epidemiology was insufficient in most HCWs of those hospitals, with lowest and highest average scores of 38.3 and 71.7 before training, respectively, but scores increased significantly after training （P〈0.01）. Proportion of TB diagnosis with chest roentgenograph at grades 3A and 2A hospitals was significantly higher one month, three months and six months after training, as compared to that at suburban hospitals （P〈0.01）. There was significant decrease （P〈0.01） in proportion of chest roentgenograph at respiratory departments in hospitals grade 3A and grade 2A after training. There was no significant difference in reporting of pulmonary TB and positive sputum smear （P〉0.05） before and after training. Conclusions HCWs in general hospitals had experience and capacity in diagnosis and treatment of pulmonary TB, but their knowledge of TB prevention policy and epidemiology was insufficient. Their ability in finding and reporting TB can not been improved with short-term training.