杭州市耐多药结核病的危险因素定性研究

Qualitative study on risk factors for multi-drug resistant tuberculosis in Hangzhou

目的研究杭州市耐多药结核病的危险因素。方法通过利益相关者深度访谈、二手资料收集以及案例分析收集所需信息,通过分级编码和Mindmanager 9.1.157进行分析和各因素与耐多药结核病因果关系图的构建。结果一级编码因素有:患者服药不规则和治疗方案不正确。二级编码包括药品不良反应、忘记吃药、疗程中断、心理因素、治疗方案不规范、检测信息迟滞等。三级编码因素有药品质量剂量剂型、医生技能、患者和家庭成员缺乏相关知识、督导员工作未尽职、经济困难、看病不便等数十项。部分三级编码因素还分解到四级和五级编码。编码的层级只反映各因素在因果关系图中的位置,并不代表重要程度。结论造成杭州市耐多药结核病的因素包括社会福利制度、社会歧视、工资改革、医疗体制改革、医疗和检测技术缺陷、药品质量和剂型问题等诸多方面,因此控制耐多药结核病也需要多方面共同努力。

Objective To determine the risk factors for multi-drug resistant tuberculosis （TB） in Hangzhou. Methods Interview of related people and data collection were conducted, and software Mindmanager 9. 1. 157 was used to construct the correlation diagram between risk factors and multi drug resistant TB. Results First-level factors included irregular drug taking and incorrect treatment therapy. Second-Level factors included adverse effects, fail to take drug, treatment interruption, psychological factor, non-standard therapy, delay in getting test results. Third-level factors included quality and type of anti TB drug, doctors＇ skill, lack of knowledge （ information）, unsatisfied performance of supervisors, poverty, inconvenience in medical care seeking. Some third-level factors can be classified into fourth-level and fifth-level factors. Levels of code only represent the location of risk factors in correlation diagram and do not reflect importance of the risk factors. Conclusion The incidence of multi-drug resistant TB in Hangzhou are influenced by many factors, such as social welfare system, social discrimination, wage system and medical care system, limits in medical treatment and detection, quality and type of anti TB drug, it is necessary to strengthen the multi-sectoral coordination to control multi-drug resistant TB.