从结核病患者就医习惯和疾病经济负担评价结核病防治策略转变的必然性

Analysis of the Necessity of New Trinity Model of TB Prevention and Control According to Health-seeking Behavior and Disease Economic Burden of TB Patients

目的从结核病患者就医习惯和疾病经济负担两个角度阐明实施"三位一体"新型结核病防治模式的必然性,为今后各地顺利推行该模式提供理论依据。方法选取云南省昭通市11个县(区)为研究现场,收集2015年10月—2016年2月期间前来结防门诊就诊的肺结核患者的就诊和治疗情况、家庭经济状况及费用开支情况。分析肺结核患者的就医习惯和其进入当地疾控中心就诊前后疾病经济负担变化,同时比较试行"三位一体"新型结核病防治模式的昭通市威信县在转型前后肺结核患者的疾病经济负担变化情况。结果共调查肺结核患者1 508例,首诊为县级医疗机构者占多数(34.0%),初诊为肺结核的比例为67.4%。患者选择县级医疗机构的主要原因为技术水平高(27.9%)和设备条件好(24.4%);首诊未选择县级疾控中心的最主要原因是不知道应该去疾控中心(48.6%)。肺结核患者进入结防机构就诊前人均总费用为2 589.5元,进入结防机构就诊后人均总费用为1 429.4元,两者差异有统计学意义(t=5.883,P<0.001);威信县转型前人均总费用为1 830.4元,显著高于转型后(808.7元),两者差异具有统计学意义(t=-2.335,P=0.023),转型后患者自付部分的门诊费用和交通费用均低于转型前。结论实施"三位一体"新型结核病防治模式后,选择当地医疗水平较高的综合医疗机构设立定点医院,不仅符合患者的就医习惯,而且定点医院技术水平高,设备条件好,更有利于患者的诊断和治疗。此外,将原来设立于疾控中心的结防门诊移交到定点医院,患者在定点医院即可享受国家的免费政策。因此,全面推行"三位一体"新型结核病防治模式势在必行。

Objective To Evaluate the necessity of the new trinity model of tuberculosis(TB)prevention and control according to health-seeking behavior and disease economic burden of TB patients,and supply strategic evidences to related health policy-making.Methods Eleven counties in Zhaotong City were selected from the TB endemic area in Yunnan province.Cases registered in Zhaotong city between October 2015 and February 2016 were investigated by questionnaire.Information about their behavior of seeking medical advice and medical expenses were collec-ted.Descriptive analysis was used to characterize the basic profiles of selected TB cases in terms of their health-seeking behavior.The TB economic costs was compared before and after CDC entry.Meanwhile,the disease economic burden of TB patients in Weixincounty was compared before and after intervention by the new model.Results Totally1508TB cases were surveyed.There were differences in TB-related health-seeking behavior.The first choice of medical institutions was county-level hospital(34%).The proportion of TB diagnosed by the first interview institution was 67.4%of county-level hospital.The main reason for choosing county-level hospital was high-level technology(27.9%)and good equipment condition(24.4%).The reason for first option not choosing the county-level CDC was that patients didn't know they should go to CDC(48.6%).Our research showed that the economic burden of TB patients decreased after visiting CDC.The average cost of TB per case before and after CDC entry was 2 589.5 CNY and 1 429.4 CNY,respectively,with statistically significant(t=5.883,P﹤0.001).The average cost of TB Patients from the Weixincounty per case before and after the new trinity model was 1 830.4 CNY and 808.7 CNY,respectively,with statistically significant(t=2.335,P=0.023).The expenses of patients inpatient and transport were lo-wer than those before new model implementation.Conclusion The new trinity model of TB prevention and control not only conforms to the patient's TB-related health-seeking behavior,but also is more advantageous to the patients diagnosis and treatment for its superb medical technology and good equipment condition,and patients can enjoy the free policy in hospital after the TB clinic transfer from CDC to designated hospital,which will not increase the economic burden of patients.