深圳市流动人口初治涂阳肺结核患者治疗管理需求调查分析

Treatment and management need analysis of new smear positive pulmonary tuberculosis patients in floating population

目的探讨流动人口初治涂阳肺结核患者对结核病治疗、管理和社会支持的需求,为更有效地开展流动人口结核病防治提供方向和重点。方法采用自制调查问卷对455例流动人口初治涂阳肺结核患者基本情况、社会经济情况、治疗管理需求和社会支持需求进行调查。结果社会经济学调查显示:82.6%的流动人口初治涂阳肺结核患者月收入低于2000元;75.8%的患者主要通过自费支付除结核病免费项目之外的其他医疗费用。治疗管理方面:44.2%的患者选择节假日(双休日)就诊,91.9%的患者认为每次就诊合适时间为4 h内,51.9%的患者认为每次复诊最多能接受的医疗费用为200元;只有28.8%的患者愿意每次到三级督导点服药,27.3%的患者愿意由家人看护或医生电话督促,在家里服药,而44.0%的患者愿意无人督促,自行服药。社会支持需求调查显示:89.5%的患者希望减免辅助药物费;92.7%的患者希望减免辅助检查费;85.9%的患者介意工作单位知道病情;69.9%的患者认为如果工作单位知道病情,将会被开除;63.3%的患者确诊后仍然继续上班;80.9%的患者需要心理医生进行心理咨询。结论流动人口初治涂阳肺结核患者的社会经济学状况较差,结核病防治机构和各部门需要关注患者治疗管理的需求,给予必要的心理支持。超过40%的患者愿意自行服药,对全程督导管理方式提出了新的挑战。

Objective To analyze the treatment,management and social support needs of new smear positive pulmonary tuberculosis（PTB） patients in floating population,in order to provide more targeted service for floating population.Methods Four hundred and fifty five cases of new smear positive PTB patients in floating population were investigated by self-designed questionnaire.Results The social-economic survey shows that,82.6% of the patients the monthly income were below 2000 yuan;in addition to the cost covered by free policy,75.8% of the patients paid the additional medical expenses by themselves.44.2% chose holiday to visit the doctor,and 91.9% felt that 4 h was most appropriate for one time visit.51.9% thought 200 yuan is the affordable upper limit for each visit.For treatment,only 28.8% was willing to go to DOT spots,27.3% would like to take medicine at home supervised by family member or by doctors through the phone call,44.0% wished to take the medicine by themselves without any supervision.The social support survey shows that 89.5% and 92.7% hoped to reduce the cost for auxiliary drugs and examinations respectively,85.9% would not like to disclose the disease to their working unit,and 69.9% thought they will be dismissed if their employers knew their disease,63.3% continued to work after TB diagnosis,80.9% needed psychological counseling.Conclusions The new smear positive tuberculosis patients in floating population were in poor socio-economic conditions.TB institutions and other related departments should give attention to the treatment and management needs of the patients and give necessary psychological support.The fact that more than 40% of the patients wished to take the medicine by themselves posts a new challenge for TB patients management.