摘要
目的分析全国31个省(直辖市、自治区;不包括我国“港澳台”地区)和新疆生产建设兵团县、乡、村肺结核患者治疗管理工作现状,为进一步提高肺结核患者治疗管理效率和质量提供科学依据。方法由中国疾病预防控制中心结核病预防控制中心和专家共同设计调查问卷,于2018年对全国2799个县(区)级结核病定点医疗机构、疾控机构和基层医疗卫生机构肺结核患者治疗管理工作情况进行调查,内容包括肺结核患者治疗管理的落实、患者的随访管理、患者的复诊与取药以及中断治疗患者的管理4个方面,从而了解县、乡、村肺结核患者治疗管理任务衔接情况。结果本次共调查2799个县(区),其中县(区)级结核病定点医疗机构设立在医院、结核病防治所(简称“结防所”)、疾控机构门诊和慢性病防治院(简称“慢病院”)的县(区)数分别为2072个(74.0%,2072/2799)、287个(10.3%,287/2799)、296个(10.6%,296/2799)和74个(2.6%,74/2799)。在落实肺结核患者治疗管理时,131个(4.7%,131/2799)县(区)级结核病定点医疗机构不传送患者信息,设立在医院的定点医疗机构不传送患者信息者占5.6%(117/2072),设立在结防所、疾控中心门诊和慢病院的定点医疗机构不传送患者信息者占1.1%(7/657),两者差异有统计学意义(χ^2=24.138,P<0.01)。1016个(36.3%,1016/2799)定点医疗机构将患者信息传送至疾控机构;912个(32.6%,912/2799)定点医疗机构将患者信息传送至基层医疗卫生机构;740个(26.4%,740/2799)定点医疗机构将患者信息同时传送至上述两个机构。通过纸质版、电子版、结核病专报系统和其他系统传送患者信息的定点医疗机构数分别为622个(22.2%,622/2799)、1121个(40.1%,1121/2799)、819个(29.3%,819/2799)和97个(3.5%,97/2799)。127个(4.5%,127/2799)疾控机构不传送患者信息;2430个(86.8%,2430/2799)疾控机构传送给乡镇卫生机构;17个(0.6%,17/2799)疾控机构传送给村级医生;225个(8.0%,225/2799)疾控机构同时传送给上述两级机构。通过纸质版、电子版、结核病专报系统和其他系统传送患者信息的疾控机构数分别为694个(24.8%,694/2799)、1611个(57.6%,1611/2799)、178个(6.4%,178/2799)和183个(6.5%,183/2799)。1153个(41.2%,1153/2799)县(区)的基层医疗卫生机构不传送随访记录表;通过纸质版、电子版、结核病专报系统和其他系统传送随访记录表的县(区)数分别为895个(32.0%,895/2799)、289个(10.3%,289/2799)、41个(1.5%,41/2799)和263个(9.4%,263/2799),有158个(5.6%,158/2799)县(区)的基层医疗卫生机构通过其他方式传送。发现患者出现不良反应或其他并发症时,374个(13.4%,374/2799)县(区)的基层医生直接告知县级医生;711个(25.4%,711/2799)县(区)的基层医生直接将患者转至县级机构;1665个(59.5%,1665/2799)县(区)的基层医生能够处理较轻的不良反应;43个(1.5%,43/2799)县(区)的基层医生告知患者到县级机构就诊。91.4%(2557/2799)县(区)的患者在每个治疗月末或治疗第2、5、6个月末(复治患者在治疗第2、5、8个月末)复诊;1.2%(33/2799)县(区)的基层医生不提醒患者复诊时间;37.8%(1058/2799)县(区)的定点医疗机构不提醒患者复诊。91.6%(2563/2799)县(区)的患者在县级定点医疗机构取药,84.9%(2376/2799)县(区)的乡镇卫生机构不提供结核病复诊服务。2240个(80.0%,2240/2799)县(区)的中断治疗患者由基层医生发现,1382个(49.4%,1382/2799)县(区)的基层医生组织开展中断治疗患者的追踪工作。结论县(区)级定点医疗机构、疾控机构和基层医疗卫生机构在肺结核患者治疗管理方面职责落实和工作衔接较好。各级应按照要求做好患者治疗管理工作,全面提高肺结核患者治疗管理的水平。
Objective To analyze the current situation of the treatment and management of pulmonary tuberculosis (PTB) patients in counties, townships and villages in 31 provinces (municipalities, autonomous regions) and Xinjiang production and construction corps, and to provide scientific basis for further improving the treatment and management efficiency and quality of PTB patients. Methods National Center for Tuberculosis Control and Prevention of Chinese Center for Disease Control and Prevention designed the questionnaire and conducted the investigation on the PTB patients treatment management of TB designated institutions and center for disease control and prevention (CDC) at county level and primary medical and health institutions among 2799 counties(districts) in 2018. The content of the questionnaire included the implementation of TB patient treatment and management, follow-up management, patients’ re-examination and refilling medicine, and management of treatment interrupted patients. The data were used to understand the task cohesion of patients’ treatment management in county (district), township and village. Results Among 2799 counties (districts) which were investigated, 2072 designated TB institutions were set up in hospitals (74.0%, 2072/2799), the numbers of TB designated medical institutions set up in TB dispensary, in CDC and in hospital for chronic diseases were 287 (10.3%, 287/2799), 296 (10.6%, 296/2799) and 74 (2.6%, 74/2799) respectively, 131 (4.7%, 131/2799) counties (districts) designated TB institutions didn’t transmit patients’ information to patients’ management institutions, and the proportion of non-transmission in hospitals was 5.6%(117/2072), and 1.1%(7/657) in TB dispensary, CDC and hospitals for chronic diseases. The difference was significant between the two types (χ^2=24.138, P<0.01). 1016 (36.3%, 1016/2799) designated TB institutions transmitted patient information to CDC, 912 (32.6%, 912/2799) transmitted patient information to primary medical and health institutions, and 740 (26.4%, 740/2799) transmitted patient information to the above two institutions at the same time. The numbers of designated medical institutions transmitting patient information through paper, electronic, National Tuberculosis Information Management System (TBIMS) and other systems were 622 (22.2%, 622/2799), 1121 (40.1%, 1121/2799), 819 (29.3%, 819/2799) and 97 (3.5%, 97/2799), respectively, 127 (4.5%, 127/2799) CDC did not transmit patient information to primary medical and health institutions. 2430 (86.8%, 2430/2799) transmitted to township health agencies, 17 (0.6%, 17/2799) transmitted to village doctors, and 225 (8.0%, 225/2799) transmitted to both levels. The numbers of CDC transmitting patient information through paper, electronic, TBIMS and other systems were 694 (24.8%, 694/2799), 1611 (57.6%, 1611/2799), 178 (6.4%, 178/2799) and 183 (6.5%, 183/2799), respectively. The primary medical and health institutions of 1153 (41.2%, 1153/2799) counties (districts) did not send follow-up records, and the numbers of counties (districts) that sent follow-up records through paper, electronic version, TBIMS and other systems were 895 (32.0%, 895/2799), 289 (10.3%, 289/2799), 41 (1.5%, 41/2799) and 263 (9.4%, 263/2799), respectively, 158 (5.6%, 158/2799) counties (districts) sent follow-up records by other methods. If the patients were found with adverse reactions or other complications, grassroots doctors of 374 (13.4%, 374/2799) counties (districts) informed the doctor at county (district) level directly, those of 711 (25.4%, 711/2799) counties (districts) directly referred the patient to the county (district) institution, those of 1665 (59.5%, 1665/2799) counties (districts) dealt with minor adverse reactions, and those of 43 (1.5%, 43/2799) counties (districts) informed patients to the county (district) institution. The patients of 91.4%(2557/2799) county (district) took re-examination at county (district) institutions at the end of each month of treatment or at the end of the second, fifth and sixth month of treatment. The primary doctors of 1.2%(33/2799) county (district) did not remind the patients to take re-examination, and 37.8%(1058/2799) designated medical institutions at county (district) level did not remind the patients. The patients of 91.6%(2563/2799) county (district) received drugs from county (district) designated medical institutions, and the township health institutions of 84.9%(2376/2799) county (district) did not provide TB re-examination services. In 2240 (80.0%, 2240/2799) counties (districts), patients with interrupted treatment were found by primary doctors, and the primary doctors of 1382 (49.4%, 1382/2799) counties (districts) organized tracing of patients with interrupted treatment. Conclusion County (district) designated medical institutions, CDC and primary medical and health institutions have a good connection of their duties in the treatment and management of TB patients. All levels should do a good job in patient treatment management according to the requirements, and comprehensively improve TB patients’ treatment management.
作者
胡冬梅
李雪
刘小秋
徐彩红
HU Dong-mei;LI Xue;LIU Xiao-qiu;XU Cai-hong(Department of Programme and Planning,National Center for Tuberculosis Control and Prevention,Chinese Center for Disease Control and Prevention,Beijing 102206,China)
出处
《中国防痨杂志》
CAS
CSCD
2019年第9期930-935,共6页
Chinese Journal of Antituberculosis
基金
加拿大国际发展部委托项目结核病控制FIDELIS甘肃项目(620301).
关键词
结核
肺
病例管理
多机构系统
卫生服务管理
数据说明
统计
Tuberculosis,pulmonary
Case management
Multi-institutional systems
Health services administration
Data interpretation,statistical