社区实施结核病分级诊疗和综合防治服务模式效果分析

Analysis on the effect of community-based TB grading diagnosis and treatment and comprehensive prevention service mode

目的总结2017年深圳市福田区社区健康服务中心实施结核病分级诊疗和综合防治服务模式试点工作取得的成效,探讨分级诊疗和综合防治服务模式试点工作的可行性和先进性。方法以社区健康服务中心2016年1月至2017年12月转诊至福田区慢性病防治院的肺结核可疑者196人为研究对象,分析肺结核可疑者的转诊情况;以社区健康服务中心2016年1月至2017年12月管理的873例肺结核患者为研究对象,分析患者的规范治疗及规范管理情况。结果 2017年社区健康服务中心转诊了188例肺结核可疑者,主动到位185例,转诊到位率98.4%,高于同期辖区综合医院肺结核可疑者的转诊到位率(34.8%),差异有统计学意义(χ2=88.9,P<0.05);高于2016年社区健康服务中心转诊可疑者数量(转诊8人)。2017年,社区健康服务中心管理了504例肺结核患者,全部患者进行了第一次入户调查,管理率达100%;按照基本公共卫生服务规范要求,对患者进行定期随访,规范管理493例,规范管理率达97.8%;同时,社区健康服务中心对187例涂阳患者进行了隔离期的督导随访管理。结论 2017年福田区社区健康服务中心实施结核病分级诊疗和综合防治服务模式试点工作,有效提高了肺结核可疑者转诊到位率,对肺结核患者做到了精细化管理,涂阳肺结核患者隔离治疗2周对保护易感人群起了较大的保护作用,总体上分级诊疗工作取得了良好的效果,值得继续推广执行。

Objective Summarize the results of the pilot project regarding the implementation of the TB hierarchical medical systems and comprehensive prevention service model in the Futian District Community Health Service Center in 2017.Method 196 people with suspected tuberculosis who were referred to Futian Chronic Diseases Control Hospital from the Community Health Service Center in 2016-2017 for the purpose of evaluating the referral of suspected tuberculosis were selected;873 tuberculosis patients managed by the Community Health Service Center from 2016 to 2017 were selected as subjects to evaluate the patient's standardized treatment management.Results In 2017,the community health service center referred 188 suspected tuberculosis patients,and 185 people took the initiative to follow.The referral rate was 98.4%,which was higher than the rate of referral of suspected tuberculosis patients in the general hospitals in the same period.The difference was statistically significant(χ^2=88.9,P<0.05);The Community Health Service Center managed 504 patients with tuberculosis.All patients underwent the first household survey with a management rate of 100%.Patients were regularly followed up according to the requirements of basic public health service regulations,and 493 people were standardized and managed.The rate reached 97.8%;The Community Health Service Center conducted a follow-up supervision of 187 smear-positive patients during the isolation period.Conclusion In 2017,the Futian District Community Health Service Center implemented a pilot program for hierarchical medical operations and comprehensive prevention of tuberculosis,effectively improved the rate of referral of suspected tuberculosis patients which enhanced management of tuberculosis patients,It has played a great role in protecting susceptible populations,overall,the hierarchical medical system has achieved good results and it is worth continuing implementation.