基层医疗卫生机构转诊肺结核可疑症状者效果分析

The effectr analysis of tuberculosis suspects referring in primary health care institutions

目的探索加强基层医疗卫生机构转诊肺结核可疑症状者对肺结核患者发现的影响。方法选择宁夏回族自治区的海原和盐池2个县在2014年进行试点，通过建立门诊处方转诊制度并为医务人员和可疑症状者提供补助，比较2个试点县干预前（2012年）和干预后（2014年）的肺结核患者发现水平。结果海原和盐池2个试点县在干预前和干预后分别登记肺结核可疑症状者为1018例和2704例，分别占总人口的0．2％（1018／545000）和0．5％（2704／549000），二者差异有统计学意义（X2=748．92，P=0．000）；2个试点县在干预前和干预后登记活动性肺结核患者分别为339例和445例，其中患者来源为转诊推荐的患者占全部患者的比例分别为25．4％（86／339）和40．4％（180／445），二者之间差异有统计学意义（X2=19．52，P=0．000）；2个试点县干预后基层医疗卫生机构推荐的肺结核可疑症状者共1185例，共检出72例活动性肺结核患者，占2个县2014年登记肺结核患者的16．2％（72／445）。结论通过加强基层医疗卫生机构对肺结核可疑症状者推荐工作可以提高肺结核患者发现水平。

Objective To explore the impact of strengthening tuberculosis （TB） suspects referring in primary health care institutions on case detection. Methods Two counties of Haiyuan and Yanchi from Ningxia Hui Au- tonomous Region were selected for the pilot in 2014, outpatient prescription referral system was established and subsidies to the medical staff and TB suspects were provided, the case detection before （2012） and after （2014） the intervention in the two counties was compared. Results The number of TB suspects registered in the two pilot counties before and after the intervention were 1018 and 2704 respectively, and the percentage among the whole po- pulation were 0. 2% （1018/545 000） and 0.50% （2704/549 000） respectively with significant difference （X2 =748. 92, P=-O. 000）. The number of active TB cases registered in the two pilot counties were 339 and 445 respectively, and the percentage from the source of referral before and after intervention were 25.4% （86/339） and 40.4% （180/445） respectively with significant difference （X2 = 19.52, P= 0. 000）. The total TB suspects referred by primary health care institutions after intervention was 1185, of which 72 pulmonary TB cases were detected and accounted for 16.2% （72/445） of TB patients registered in the same period. Conclusion The TB case detection can be improved by strengthening TB suspects referring in primary health care institutions.