苏州市流动肺结核患者就诊延迟状况及影响因素

Study on health-seeking delay and influencing factors associated with pulmonary tuberculosis among floating population in Suzhou

目的了解流动肺结核患者就诊延迟状况,探索其影响因素,为结核病早发现提供依据。方法通过专题讨论小组、个人深入访谈和关键人物访视进行定性研究。对418例流动肺结核初治患者采用回顾性队列的定量调查,通过面对面询问和査阅病历的方式收集患者发病就诊信息,应用非条件Logistic回归进行影响因素分析。结果苏州市流动肺结核患者就诊延迟率为38.76%(163/418),就诊延迟时间43(24,8&25)d。访谈结果提示结核病防治意识和知识差、高流动性、经济条件差,工作忙,健康宣教不深入是就诊延迟的影响因素。女性(OR=2.134,95% CI:1.374~.314)、日工作时间>8h (OR=1.772,95%C7: 1.118-2.808).痰涂片阳性(0R=1.709,95% CI:1.126~2.595)是导致流动肺结核患者就诊延迟的影响因素,初始症状越轻,就诊延迟的风险越大[轻、中、重的OR(95%CI)分别为 4.567(1.916~10.887)、3.299(1.356~8.028)和3.011(1.242~7.301)]知晓结核病防治核心信息是流动肺结核患者就诊延迟的保护因素(OR=0.585,95% CI:0.383~0.893):结论流动肺结核患者就诊延迟现象较严重,需针对结核病防治意识和知识差、健康宣教不深入等原因进行具体研究,针对高危人群进行有针对性的宣教,降低结核病延迟就诊率。

Objective To understand tlu* status of delay in seeking health care among patients with tuberculosis in floating population and explore the irlative influencing factors, so as to provide basis for prevention and control of tuberculosis. Methods Qualitative study was conducted with focus group discussion, in-depth interview and key informant interview. A total of 418 cases of tuberculosis patients were included in the retrospective cohort quantitative interview. By means of face to face questionnaire and the clinical cases, data on morbidity and treatment were collected for all participants. The association between delayed health seeking and clinical characteristic were analyzed by non-conditional logistic regression method. Results A total of 162 (38.76%) tuberculosis patients in floating population were delayed , and the delayed time was 43(24,88.25)d. Poor tuberculosis knowledge and awareness, high mobility, poor economy. busy work, and inadequate health education for floating population were factors to influence health seeking(k*kiy. After adjustment for multivariate, patent delay in seeking health was positively associated with female(OR=2.134, 95%CI:1.374-3.314), working more than 8 hours a day (OR =l.772,95%CI:1.118-2.808) and sputum smear positive (OR=1.709, 95%CI: 1.126-2.595). OR values (95%CI values) of patients with patent delay in seeking health were associated with mild initial morbidity (OR= 4.567, 95% CI:1.916-10.887), moderate initial morbidity (OR =3.299, 95% Cl:1.356-8.028) and severe initial morbidity (OR =3.011 , 95%CI: 1.242-7.301) and increased severity of initial morbidity was associated with decreased risk of patent delay. Well awareness in health knowledge was the protective factor, which was the key information for prevention (OR=0.585, 95% Cl:0.383-0.893). Conclusions It is quite serious that tuberculosis patients in floating population delays in seeking diagnosis. The reasons such as poor knowledge and awareness of tuberculosis prevention should be initiated. Education for high risk population should be taken to reduce the proportion of patient delay.