强化性病门诊规范服务对体格检查质量的影响分析

Impact of promoting standard services in STD clinics on physical examination and laboratory examinations

目的对医疗机构进行性病规范化服务干预,评估干预对性病门诊体格检查和实验室检查的影响,为改善上海市公立性病门诊服务质量提供依据。方法在上海徐汇、闵行等区,随机抽取6家具有性病诊疗资质且符合入选条件的综合性医院的性病门诊作为研究现场,并把条件相当的门诊随机分入干预和对照两组。干预期为6个月,对前来就诊（初诊）的性病患者或者可疑患者进行问卷调查,采用卡方检验等方法进行统计分析。结果调查对象为15-49岁性病患者或可疑患者,基线共调查860人,其中干预组412人,对照组448人。经6个月干预后,调查对象869人,干预组451人,对照组418人,在体格检查方面,干预组在＂全身检查＂、＂触诊＂和＂翻开包皮/阴唇＂项目均以干预后为高（χ^2=92.57,P〈0.0001;χ^2=12.49,P=0.0004;χ^2=16.58,P〈0.0001）,而对照组服务提供率没有改变。干预组,干预前后＂使用窥阴器＂检查率由20.33%增加到了36.60%（χ^2=12.14,P=0.0005）,而对照组干预前后没有变化（χ^2=2.52,P=0.1123）;干预组＂双合诊＂检查率,由干预前的4.95%提高到干预后的25.26%。对于实验室检查的建议率,无论对照组还是干预组,干预前、后均未见显著改变。结论干预措施对于性病门诊体格检查服务的提供有显著促进作用。

Objective To evaluate effects of promoting standard services in sexually transmitted disease （STD） clinics on physical examination and the laboratory examinations to provide evidences for improving the quality of service of STD clinics in Shanghai. Methods Six STD clinics meeting inclusion criteria in general hospitals in Xuhui, Mingxing and other districts of Shanghai were selected as the study sites and divided into control group and in- tervention group randomly. Intervention period was 6 months. STD patients or suspected patients were interviewed with a questionnaire. One-way ANOVA and other statistical methods were used to analyze the data. Results A total of 860 STD patients or suspicious patients were interviewed at baseline, including 412 in the intervention group and 448 in the control group, who were aged between 15 and 49 years. After 6 months of intervention, 869 were interviewed, including 451 in the intervention group and 418 in the control group. The rate of the patients who got ＂general examination＂, ＂palpation＂, ＂turning over the prepuce/labia vulvae＂ in the intervention group was higher after intervention （Z2=92.57,P〈0.0001;x^2=12.49,P =0.0004;x^2=16.58,P〈0.0001）. However, it was not changed in the control group. The rate of ＂using vaginal speculum＂ rose from 20. aa% before intervention to 36.60% after intervention （x^2=12. 14,P=0.0005）, but it was not changed in the control group （x^2=2.52,P= 0. 1123）. The rate of ＂bimanual examination＂ rose from 4.95% to 25.26% in the intervention group. The rate of suggesting laboratory examination was not markedly changed in either the intervention group or the control group. Conclusion Intervention can improve the service quality of STD clinics.