北京中医药大学东方医院转诊肺结核患者到位情况及影响因素分析

Factors affecting referral and tracing of pulmonary tuberculosis cases reported by Dongfang Hospital Affiliated to Beijing University of Chinese Medicine

目的 了解北京中医药大学东方医院（综合医院）转诊肺结核患者的到位情况。方法 追踪调查2011年1月至2013年12月在东方医院门诊和住院的患者中，临床诊断为“肺结核”的156例患者，全部给予转诊和网络上报，采用电话追踪询问的方式，询问患者去结核病防治所或胸科医院的转诊到位就诊和追踪到位就诊情况。以患者转诊到位率为分析指标，收集不同年龄段、性别、有无医保、免费治疗是否知晓、有无稳定收入、是否担心社会偏见、就诊时间是否超过7d、转诊科室是否为呼吸科等情况，使用SPSS 15.0统计学软件对数据进行整理和统计学处理，分别应用χ^2检验进行统计学分析，以P〈0.05为差异有统计学意义。结果 156例患者中到结核病防治所就诊者106例，在胸科医院诊治者29例，回原籍诊治者6例，失访者15例。转诊到位者96例，到位率61.54%（96/156）；追踪到位45例，追踪到位率28.85%（45/156）；总体到位率90.38%（141/156）。住院患者的转诊到位率明显高于门诊患者，分别为90.00%（27/30）vs 54.76%（69/126） （χ^2=12.712，P＜0.01）；不同性别、有无医保、有无稳定收入、是否知晓免费医疗、转诊科室是否为呼吸科等因素的转诊到位率分别为94.85%（92/97） vs 83.05%（49/59）、98.09%（103/105） vs 74.51%（38/51）、97.37%（111/114） vs 71.43%（30/42）、 96.21%（127/132） vs 58.33%（14/24）、98.70%（76/77） vs 82.28%（65/79）］，上述各项比较，差异均有统计学意义（χ^2值分别为5.87、19.34、20.87、29.31、12.10；P值分别为＜0.05、＜0.01、＜0.01、＜0.01、＜0.01）。结论 东方医院转诊肺结核患者的总体到位率较高；不同性别、有无医保、有无稳定收入、是否知晓免费医疗、转诊科室是否为呼吸科等是影响转诊到位率的重要因素。

Objective To understand referral in place situation of pulmonary tuberculosis patient in Dongfang Hospital Affiliated to Beijing University of Chinese Medicine. Methods By the mean of telephone follow-up, we investigated referral,tracking situation of 156 cases with pulmonary tuberculosis reported by Dongfang Hospital from January 2011 to December 2013. Taking referral in place rate as analysis indicator, we collected the information including ages, gender, health insurance, awareness of free treatment policy, income stablility, concern for social prejudice,seeking care delay, the referral department. SPSS 15.0 statistical software is used for collation and statistical analysis, χ^2 tests were applied to analysis, and statistical significance is on the basis of P〈0.05. Results Among 156 cases with tuberculosis,106 cases were treated in tuberculosis dispensaries,while 29 cases in Chest Hospital, 6 cases went back to their hometowns, 15 cases were lost for follow-up. Ninety-six cases were referred and the arrival rate of the referred cases was 61.54%（96/156）;60 were tracked and the arrival rate of the tracked cases was 75.00% （45/60）. The overall in place rate was 90.38% （141/156）; Inpatient referral in place rate was significantly higher than outpatients （90.00%（27/30）vs 54.76%（69/126））（χ^2=12.712,P〈0.01）; There are significant differences between referral rate in place of different gender, whether have health insurance, have or no stable income, know or unknown free policy, whether referral departments is respiratory department or not （referral in place rate 94.85% （92/97） vs 83.05% （49/59）,98.09% （103/105） vs 74.51% （38/51）, 97.37% （111/114） vs 71.43% （30/42）, 96.21% （127/132） vs 58.33% （14/24）, 98.70% （76/77） vs 82.28% （65/79 respectively）; χ^2=5.87,19.34,20.87,29.31,12.10 respectively; P〈0.05,〈0.01,〈0.01,〈0.01,〈0.01 respectively）. Conclusion The general referral in place rate of pulmonary tuberculosis cases reported by Dongfang Hospital is generally high; different gender, whether have health insurance, whether have stable income, whether known of free policy, whether referral from respiratory department are the important factors affecting the referral in place rate.