上海市肺结核病防治示范区I-PPM模式的实施现状与效果研究

Evaluation on implementation and effect of I-PPM model for TB control in the demonstration districts in Shanghai

目的:了解上海市肺结核病防治示范区I-PPM模式的实施情况,总结上海大城市结核病防治的效果、经验与挑战,提出进一步完善的建议。方法:以上海市7个结核病防治示范区为研究现场,采用现有资料收集、补充问卷的定量调查方法和深入访谈、小组讨论的定性调查方法。结果:各示范区运用结防PPM模式于病例发现、转诊追踪、确诊治疗、督导化疗和健康教育等各个过程。2009年示范区新涂阳肺结核患者的治愈率达到88.3%,自付费用占家庭年收入的比例约为5%。患者总体满意超过90%,结防人员满意度3.55分。结论:该模式有效整合资源,加强了疾病预防控制中心(CDC)的监督管理职能,实现了患者在医疗机构的"非中心化"发现、提高了地区结核病诊疗水平,充分发挥了社区督导管理的便利可及性。但在提高人力可持续性和控制医疗费用方面仍需研究有效的机制来提高I-PPM的效果。

Objective： To study the construction and implementation of the tuberculosis （ TB ） I-PPM control model in different demonstration districts in Shanghai and to evaluate the primary TB control effect by this model. Methods： The 7 demonstration districts in Shanghai were selected as the study fields. Qualitative research methods including existing data collecting and questionnaire investigation and quantitative research methods including in-depth interview and group discussion were adopted. Results： Seven districts improved their TB cases finding, treatment compliance and control quality by applying the I-PPM model to the whole process of case-finding, referral and tracing, diagnosis and treatment, chemotherapy management, as well as health education. In 2009, the cure rate of new smear- positive pulmonary TB cases reached 88.3%. The proportion of out-of- pocket payment for TB treatment to family income per year was about 5%. The satisfaction rate in patients surpassed 90% and the satisfaction score in TB control staff was 3.55. Conclusion： TB I-PPM control model contributed to effectively integrate health resources, strengthen the regulatory functions of the CDC, realize decentralization of cases finding in different medical institutions, improve the capability on TB diagnosis and treatment, and bring out the advantage of convenience and accessibility for TB management in CHSs. However, more effective mechanisms were needed to improve human resource sustainability and controlling medical fees in TB treatment, which would be expected to advance the effect of the I-PPM model.