多次抗结核治疗结核病患者诊疗经历与诊疗费用分析

Health Care-seeking Experiences and Expenditures in Tuberculosis Patients Underwent Multiple Anti-tuberculosis Therapies

目的了解四川省全球基金项目多次抗结核治疗的结核病患者寻求医疗服务的经历及其治疗的医疗费用,为今后结核病防治工作提供参考。方法采用分层整群抽样的方法,在四川省全球基金项目地区抽取1个区、1个县作为研究现场,采用自行设计的调查问卷对2011-04/08期间所有就诊的既往有过2次及以上抗痨治疗史的结核病患者进行调查。结果共调查81名患者,分别有71.6%和91.4%的结核病患者首次和第2次治疗在县疾控中心进行,88.7%结核病患者在第1次治疗中使用国家推荐的初治方案,70%的患者在第2次治疗中按复治方案完成。18.8%和14.8%的患者在第1次或第2次治疗中未能按国家推荐的相应方案完成治疗。首次治疗和再次治疗的结核病患者的医疗费用的中位数分别为800和1200元,低收入家庭的结核病治疗负担较重,支出的治疗费用占家庭人均收入的比例远远高于高收入家庭(P<0.05)。结论结核病患者能够及时到定点机构就诊,但是依然面临较重的经济负担,应重视对居民的健康教育,加强对结核病患者的管理。

Objective To analyze health care-seeking experiences and health related expenditures of tuberculosis（ TB） patients with multiple anti-tuberculosis therapy in Sichuan to provide references for TB prevention and control. Methods A cross-sectional study was conducted in one county and one district covered by global funds in Sichuan. The TB patients with 2 or more anti-TB therapies were investigated with self-administrated questionnaires during Apr. to Aug.,2011. Results Among 81 patients,71. 6% and 91. 4% patients had been treated in the county / district CDCs for the first and second treatment episode. There were 88. 7% patients received the standardized 6- month anti- TB therapy（ 2HRZE /4HR） in their first treatment episode, and70% patients had took the 8- month therapy（ 2HRZSE /6HRE） in their second treatment episode. Respectively 18. 8% and 14. 8% patients failed to complete their first or second treatment. The median of health related expenditures were 800 and 1200 CNY for the first and second treatment, respectively. The burden in low income households was heavier than that in high income households,as the proportion of disease costs in the income per capital was higher in low income households than that in high income households. Conclusion TB patients would like go to county dispensary for health seeking; however,the economic burden of TB treatment is heavy. More health education measures should be carried out and the management of TB patients should be strengthened.