陕西省基本公共卫生结核病患者健康管理服务项目实施效果评价

Evaluating the implementation effect of tuberculosis patients health management services for Basic Public Health Projects in Shaanxi Province

目的对陕西省基本公共卫生结核病患者健康管理项目有关政策及实施效果进行评价,为进一步完善、落实基层医疗机构结核病防治工作模式提供借鉴。方法通过收集陕西省卫生健康委员会下发的《陕西省基本公共卫生结核病患者健康管理服务项目实施及考核方案(2017版)》、《陕西省基本公共卫生结核病患者健康管理服务项目实施及考核方案(2018版)》等文件,提炼工作目标、工作任务、工作流程、经费预算及绩效考核等五部分内容。结合专项督导调研,以及收集2018年《基层医疗机构结核病防治工作季报表》、《全国结核病患者信息管理系统》数据,评价陕西省基本公共卫生结核病患者健康管理服务项目的具体做法、组织实施情况及效果。2018年陕西省基层医疗机构向县级定点医院共推介到位43816例肺结核可疑症状者,其中确诊4183例活动性肺结核患者,落实管理普通肺结核患者21401例,管理利福平耐药患者318例。结果基层医疗机构推介初诊患者数占全省定点医院2018年登记初诊者数的37.05%(43816/118266),各季度[分别为22.08%(6565/29729)、36.13%(10892/30150)、39.81%(11028/27702)、49.96%(15331/30685)]呈上升趋势(χ^2趋势χ趋势2=4921.82,P=0.000);其中基层医疗机构推介到位的肺结核可疑症状者中确诊活动性肺结核患者占全省登记活动性肺结核患者的18.00%(4183/23237),低于其他来源(包括转诊、追踪、主动就诊等)确诊患者的比率(25.59%,19054/74450),差异有统计学意义(χ^2=4498.52,P=0.000)。2018年通知基层管理的普通肺结核患者通知率为93.81%(21798/23237),管理率为98.18%(21401/21798),签约率为92.49%(20161/21798),管理率和签约率均达到国家要求的90%的目标;利福平耐药患者通知率仅为60.98%(325/533),管理率为97.85%(318/325),签约率为88.62%(288/325),管理率达到国家要求的90%的目标,签约率略低于国家要求的90%的目标。结论陕西省基本公共卫生结核病患者健康管理服务项目加强了基层医疗机构可疑肺结核患者推介工作,促进了肺结核患者管理率、签约率目标的实现,值得其他地区借鉴;但可疑肺结核患者推介质量及利福平耐药肺结核患者签约服务有待进一步提高。

Objective The aim of this was to evaluate the policy and implementation effect of tuberculosis patients health management services for the basic public health projects in Shaanxi Province, and provide reference for further improving and implementing the tuberculosis prevention and control mode in primary medical institutions.Methods The implementation and assessment programs of tuberculosis patients health management service for the basic public health project in Shaanxi Province issued in 2017 and 2018 by the Health Commission of Shaanxi Province were collected, and then the five contents of work objectives, tasks, workflow, budget and performance appraisal were refined. Combined with special supervision and research as well as the data of “Quarterly Report on Tuberculosis Prevention and Control in Primary Medical Institutions” and “National Tuberculosis Patient Information Management System”, this paper evaluated the specific practices, organizational implementation and effect of the tuberculosis patients health management service for the basic public health projects in Shaanxi Province. In 2018, 43816 cases of suspected symptoms of pulmonary tuberculosis were recommended to county-level designated hospital by primary medical institutions, of which 4183 cases were diagnosed as active pulmonary tuberculosis, and 21401 cases with common pulmonary tuberculosis and 318 rifampicin-resistant tuberculosis patients were managed.Results The number of recommended newly diagnosed patients by primary medical institutions accounted for 37.05%(43816/118266) of the total number of first registered in provincial designated hospitals in 2018, and the number in each quarter (Q1: 22.08%(6565/29729), Q2: 36.13%(10892/30150), Q3: 39.81%(11028/27702), and Q4: 49.96%(15331/30685);χ^2trendχtrend2=4921.82, P=0.000) showed an upward trend. Among the suspected symptoms of tuberculosis recommended by primary medical institutions, the confirmed active pulmonary tuberculosis patients accounted for 18.00%(4183/23237) of active pulmonary tuberculosis patients in the province, which was lower than other sources of confirmed patients (including referral, follow-up, and active visits) with the rate of 25.59%(19054/74450), and the difference was statistically significant (χ^2=4498.52, P=0.000). The notification rate, management rate, and contracted rate of common pulmonary tuberculosis were 93.81%(21798/23237), 98.18%(21401/21798), and 92.49%(20161/21798), respectively, which reached the goal of 90% of the national requirements. The notification rate of rifampicin-resistant tuberculosis patients was only 60.98%(325/533), while the management rate was 97.85%(318/325), reaching the goal of 90%;and the contracted rate was 88.62%(288/325) that slightly lower than the goal of 90%.Conclusion The tuberculosis patient health management service of the basic public health project in Shaanxi Province has strengthened the recommendation of suspected tuberculosis patients in primary medical institutions, and promoted the realization of the goal on the management rate and contract rate of tuberculosis patient, which can provide reference for other areas. However, the quality of recommendation for suspected tuberculosis patients and the contracting service for rifampicin-resistant tuberculosis patients need to be further improved.