2009—2011年北京市密云县社区及综合医疗机构肺结核患者转诊到位情况调查分析

Analysis of referral and tracing of pulmonary tuberculosis cases reported by non-TB institutes from internet-based infectious disease reporting system from 2009 to 2011 in Miyun county

目的了解北京市密云县结核病控制工作纳入社区卫生管理现状,探讨社区综合医疗机构在肺结核防治中发挥的转诊追踪作用。方法收集并分析2009年1月至2011年12月社区卫生服务中心及综合医院疾病监测报告信息及密云县结核病防治所的月报、季报、年报及患者的初诊、追踪情况登记资料。期间密云县非结核病防治机构网络实际报告肺结核患者及疑似患者523例。结果2009—2011年网络直报患者的未查痰者占68.6%(359/523)。从社区和综合医院向结核病防治所实现100.0%转诊,3年的转诊到位率为65.2%(341/523),追踪到位率为66.7%(64/96),2009、2010和2011年追踪到位率分别为82.1%(23/28),73.0%(27/37),45.2%(14/31),呈逐年下降的趋势(χ2趋势性=10.1,P<0.05),3年的总体到位率为93.9%(491/523)。到位患者的确诊率为58.0%(285/491)。结论密云县社区及综合医疗机构在肺结核患者的发现中起了重要作用,使得结核病防治工作得到良好的可持续发展。

Objective To understand the situation of referral and tracing of pulmonary tuberculosis（PTB） cases reported by non-TB institutes from internet-based infectious disease reporting system from 2009 to 2011 in Miyun county in order to explore the measures to improve case detection.Methods TB control monthly reports,quarterly report and annual reports of Miyun county from 2009 to 2011 were collected and analysed,523 PTB cases and suspects were reported by non-TB institutes during that period.Results 68.6%（359/523） of the cases reported in internet-based infectious disease reporting system did not take sputum exam.The referral rate was 100.0%,the referral arrival rate was 65.2%（341/523） and tracing arrival rate was 66.7%（64/96）.The tracking arrival rate were 82.1%（23/28）,73.0%（27/37） and 45.2%（14/31）,respectively in 2009,2010 and 2011,which were declined year by year（χ2trend=10.1,P0.05）.The overall arrival rate was 93.9%（491/523）.Among patients arrived in TB dispensary,58.0%（285/491） were confirmed as pulmonary tuberculosis.Conclusion Non-TB institutes play an important role in TB case detection.Standardized working mechanism of TB recording,reporting and referral should be established,and sputum examination rate should be increased to improve PTB case detection.