678例初治肺结核病人延迟就诊情况调查及影响因素分析

Investigation of delayed treatment of 678 pulmonary tuberculosis patients and analysis of its influencing factors

目的分析肺结核病人延迟就诊影响因素,为提高结核病防控质量提供借鉴。方法对2015-2016年间在渭南市华州区疾病预防控制中心就诊的678例初治肺结核病人延迟就诊情况进行调查分析。结果 678例初治肺结核病人延迟就诊者占15.49%(105例);60岁以上、外地、初中及以下学历和农民病人的延迟就诊发生率分别为26.90%、30.67%、20.84%、18.00%,均明显高于60岁及以下、本地、高中及以上学历和城镇病人的10.81%、13.60%、4.85%、13.68%,差异有统计学意义(P<0.05);573例就诊及时病人对肺结核临床症状、传播途径、防治措施、免费政策知晓率分别为70.86%、64.92%、60.91%和12.39%,均明显高于105例就诊不及时病人的48.57%、53.33%、43.81%、5.71%,就诊及时与延迟病人上述指标比较,差异有统计学意义(P<0.05);105例就诊延迟病人中,按肺结核自行服药者占28.57%、怀疑肺结核而未治疗者占42.86%、误诊未按肺结核治疗者占28.57%;影响病人延迟就诊的心理因素有:认为自己随便吃药就好了者占15.24%、认为不吃药扛一扛就好了者占13.33%、内心自卑怕受歧视者占28.57%、其他心理者占14.29%。结论初治肺结核病人延迟就诊问题与病人对肺结核防治知识、免费政策的掌握与了解密切相关,不同人群病人延迟就诊情况有明显差异。应进一步加强结核病防治知识、政策宣传,提高民众自我防护能力,降低肺结核传播风险。

Objective To analyze the factors affecting the delayed treatment of patients with pulmonary tuberculosis, and provide reference for improving the quality of tuberculosis prevention and control. Methods A survey of 678 cases of newly diagnosed pulmonary tuberculosis patients who visited the Huazhou District Center for Disease Control and Prevention in Weinan City between 2015 and 2016 was conducted. Results The treatment of 15.49% （105 patients） of the 678 patients with initial pulmonary tuberculosis were delayed. The incidence of delayed treatment for patients over 60 years old, living in rural areas, receiving junior middle schools education and below, and farmers＇ patients were 26.90%, 30.67%, 20.84% and 18.00% respectively. They were significantly higher than that of those aged 60 and below, living in local areas, receiving high school education or above, which were 10.81%, 13.60%, 4.85%, 13.68% respectively. The difference was statistically significant （P〈0.05）. The rate of awareness of clinical symptoms, transmission routes, prevention measures, and free policies of 573 cases of patients with tuberculosis were 70.86%, 64.92%, 60.91%, and 12.39%, respectively, which were significantly higher than those of 105 patients who did not receive timely treatment, which were 48.57%, 53.33%, 43.81%, 5.71% respectively. There were statistically significant differences （P〈0.05） between the patients receiving timely treatment and delayed treatment. Of the 105 patients with delayed treatment, 28.57% were taking self-administration of pulmonary tuberculosis, 42.86% were untreated with suspected tuberculosis, and 28.57% were misdiagnosed without tuberculosis treatment. The psychological factors affecting patients＇ delayed treatment were ： 15.24% thought that they would take medicine casually, 13.33% thought that they wouldn＇t eat medicine, 28. 57% felt that they were afraid of being discriminated against, and others were 14. 29%. Conclusion The problem of delayed treatment for initial diagnosed tuberculosis patients is closely related to the patient＇s knowledge and free policy of tuberculosis prevention and control. There are significant differences in the delay of patient treatments for different groups of patients. We should further strengthen the prevention and control of tuberculosis and publicize policies to improve people＇s self-protection and reduce the risk of tuberculosis transmission.