提高新发涂阳肺结核病人发现率方法的研究

The research of methods to increase case notification rate of new smear positive pulmonary tuberculosis cases

目的 促进肺结核登记报告,提高病人发现率。方法 根据新发涂阳登记率,采用分层单纯随机抽样方法在山东省确定6个县作为调查点。采取积极的干预措施,进行广泛深入地宣教,并在采取措施前后对健康人群、肺结核病人及综合医院进行调查、对比。结果 通过采取措施,有症状主动到结核病防治所就诊者,由干预前的29%增加到干预后的270%;综合医院收住肺结核由030%下降到014%,漏报率由282%下降到159%。1995年新发涂阳登记率为1345/10万,较干预前1994年的1194/10万有明显提高(P<0.01)。采取干预措施后的4年(1994～1997)登记的新发涂阳病人,比干预前的4年(1990～1993)增加434%(2940/2050)。结论 加强宣教,强调依法归口管理、综合医院建立胸透登记、转诊,可以有效地提高新发涂阳病人发现率。

Objective To improve and increase the rate of case-finding.Methods 6 counties were chosen at random according to the rate of new smear positive pulmonary tuberculosis cases from 3 different level,and adopted some vigorous measures in the counties.We tried our best to educate people to have the knowlege of TB symptoms and made them know the necessity for patients to see TB doctor in time.Then we investigated and compare health people,pulmonary TB patients and inpatients in general hospitals before and after the adopted measeures.Result Through wide propaganda and health education,people get to know much about tuberculosis.More and more people who have tuberculosis symptoms are willing to go to tuberculosis dispensary.The rate of patients going to see TB doctors directly went up from 2.9%to 27.0% before and after interventien.For issued documents on tuberculosis classified management,the pulmonary tuberculosis inpatients in general hospital dropped from 0.30%to 0.14%.During the same period,the rate of failing to report came down from 28.2%to 15.9%.After adopting the measures,the rate of new smear positive pulmonary tuberculosis was 13.45/100 000 in 1995,which raised obviouslly,comparing with 11.94/100 000in 1994 before intervention ( P<0.01) .The new registered smear positive cases increased 30.3%,2 050 comparing with 2 940,before interventien of 4 years(1990～1993)and after interventien of 4 years(1994～1997).Cnclusion It's very important to strengthen propaganda and education.And stressing on pulmonary tuberculosis patients' classified management is necessary and efficient.The general hospital should set up fluoroscopy register.These measures can raise case notification rate of new smear positive pulmonary tuberculosis case effectively.