医联体内宫颈疾病双向转诊模式的研究

Study of a two-way referral mode for the treatment of cervical disease within a medical alliance

目的探索在医联体内建立宫颈疾病防治双向转诊模式,实现对宫颈癌前病变和宫颈癌患者的早期诊断和治疗。方法2018年1至12月闵行区非医联体内4家社区卫生服务中心的宫颈癌筛查阳性的2515例患者为对照组,医联体内4家社区卫生服务中心的宫颈癌筛查阳性的2384例患者为医联体组。对照组沿用原来的管理模式,医联体组在医联体内采用集规范化筛查、转诊、随访、健康教育及专业培训为一体的双向转诊管理模式。比较两组宫颈癌筛查阳性妇女的有效就诊率、得到有效就诊的时间,宫颈癌前病变和早期宫颈癌的检出率和治疗率。结果医联体组有效就诊率65.5%(1562/2384)高于对照组39.9%(1003/2515)(χ^2=322.537),得到有效就诊时间[(16.9±11.5)d]低于对照组[(25.7±20.9)d](t=-3.466)。医联体组宫颈低级别癌前病变的检出率6.38%(152/2384)高于对照组2.94%(74/2515)(χ^2=32.788),医联体组宫颈高级别癌前病变的检出率3.82%(91/2384)高于对照组1.71%(43/2515)(χ^2=20.430),医联体组宫颈癌前病变治疗率90.12%(319/243)高于对照组78.63%(92/117)(χ^2=8.869),差异均有统计学意义(P均<0.05)。结论医联体内宫颈疾病防治双向转诊的管理模式,能实现对宫颈癌前病变和宫颈癌患者的早期诊断和治疗,以期降低宫颈癌的发病率和死亡率,节约卫生资源,具有长远的经济意义和而社会意义。

Objective To explore the establishment of a two-way referral system for the treatment of cervical diseases within a medical alliance.The two-way referral system was introduced to reduce the morbidity and mortality of cervical cancer through better management of patients’who have tested positive for cervical disease,screening effectively for early diagnosis and treatment of cervical precancerous lesions,and providing early interventions for cervical cancer patients.Methods The control group consisted of 2,515 patients who had screened positive for cervical disease between January 2018 and December 2018 at one of four community health service centers that were not within the medical alliance.The experimental group consisted of 2,384 patients who had screened positive for cervical disease at one of four community health service centers in the medical alliance.The control group was treated using the original management mode;the experimental group’s treatment was managed within the two-way referral system,which included standardized screening,referral,follow-up,health education,and professional training.The hospital visit rates,time intervals from diagnosis to the start of interventions,detection rates,and treatment rates were observed for both groups of women.Results The hospital visit rates,detection rates,and treatment rates were higher for those in the experimental group than the control group.The time interval from receiving a diagnosis to the first hospital visit was(16.9±11.5)days for patients in the experimental group and(25.7±20.9)days for those in the control group.The difference was a statistically significant(-0.05).Conclusion The management of cases in a two-way referral system within a medical alliance facilitates patients receiving earlier diagnosis and treatment for cervical pre-cancerous lesions and malignant tumors.Such efficiency improvements may reduce morbidity and mortality as well as help control medical costs,all of which have long-term economic and social significance.