医疗机构转诊医生对肺结核患者转诊到位率的影响

Role of referral doctors in enhancement of referral arrival rate of pulmonary tuberculosis patients

目的探讨医疗机构医生对肺结核患者转诊效果的影响,为制定结核病防治策略提供参考。方法选择肺结核患者转诊到位率低的两个县作为干预县和对照县,干预县由责任医生对需转诊的肺结核患者按项目设计要求进行转诊前的健康教育,对照县维持原工作模式不变;分别对两个县医疗机构报告的150例肺结核患者进行问卷调查。结果干预县肺结核患者转诊到位率由干预前的23.8%提高到66.7%(χ2=83.7,P<0.05),亦显著高于对照县转诊到位率41.3%(χ2=19.38,P<0.05)。干预县肺结核患者结核病防治基础知识有81.3%来源于转诊医生转诊前的健康教育,显著高于对照县(χ2=53.7,P<0.05);转诊未到位患者中,干预县和对照县分别有46.9%和51.3%是因为不了解结防机构,有40.8%和30.6%是因为转诊医生没解释清楚而未到位。结论转诊医生对肺结核患者转诊前的健康教育是提高转诊到位率的重要措施之一,但转诊医生的健康教育水平还有待进一步提高。

Objective To investigate the role of referral doctors in enhancement of referral arrival rate of pulmonary tuber culosis patients.Methods Two counties with low referral arrival rate of tuberculosis cases were selected as the intervention county and the control county.Health education was implemented in intervention county with tuberculosis patients required re ferral,while the control county maintained the original operating mode,and then 150 tuberculosis cases reported by medical in stitutions in the two counties were investigated by questionnaire survey.Results The referral arrival rate of tuberculosis pa tients in intervention county increased from 23.8% to 66.7%,significantly higher than that before intervention（χ2 = 83.7,P 0.05） and also significantly higher than in control county（41.3%,χ2 = 19.38,P0.05）.Besides,81.3% of patients in interven tion county obtained the TB control knowledge from health education by referral doctors before referral,significantly higher than that of control county（χ2 = 53.7）.The cause of tuberculosis cases failed to referral was due to unfamiliar of TB control insti tutions accounted for 46.9%（intervention county） and 51.3%（control county）,and the cause of other tuberculosis cases failed to referral was due to unclear explanation by the referral doctors accounted for 40.8% and 30.6% in the intervention county and control county,respectively.Conclusions Health education given by referral doctors before referral is one of the important measures for enhancing the referral arrival rate of tuberculosis patients.Thus the effort of upgrading the health education level of referral doctors is indicated.