沈阳市205例住院肺结核患者就诊延迟及影响因素分析

Analysis of visit delay and its risk factors among 205 hospitalized tuberculosis patients in Shenyang

目的分析沈阳市肺结核患者就诊延迟的现状及其影响因素,为制定改善措施提供依据。方法采用前瞻性资料收集的方法对2017-2018年沈阳市第十人民医院(沈阳市胸科医院)结核病二科收治的确诊为肺结核且≥15岁的205例住院患者进行问卷调查和临床资料收集,包括患者一般人口学特征[年龄、性别、体质量指数(BMI)、婚姻状况、文化程度、是否为流动人口、是否饮酒、是否吸烟和有无医疗保险及类型(费别)等],临床特征[包括疾病严重程度、治疗类型(初、复治)、是否耐药、首诊机构、是否因症就诊、有无空洞、痰涂片检查结果],以及对结核病防治知识知晓情况(包括对8条结核病防治核心知识的基本认知,如对结核病的传播途径、可疑症状、结核病防治相关免费政策及对防治专业机构是否了解等情况)等。以患者自出现肺结核症状之日起至首次到医疗机构就诊之日止的时间间隔天数≥14d作为就诊延迟的判断标准,采用χ2检验和多因素logistic回归法对就诊延迟患者的影响因素进行分析。结果205例调查患者中,就诊延迟110例,就诊延迟率为53.7%。多因素logistic回归结果显示,就诊距离较远[OR(95%CI)=3.405(1.102~10.518)]、病情一般[OR(95%CI)=12.384(3.558~43.109)]、治疗类型为初治[OR(95%CI)=2.099(1.109~3.974)],以及饮酒[OR(95%CI)=2.283(1.212~4.299)]是就诊延迟的危险因素。结论沈阳市住院肺结核患者就诊延迟现象明显,就诊距离较远、临床症状一般、初治患者,以及有饮酒史的肺结核患者易出现就诊延迟,应加强对社会人群的结核病相关知识的宣传教育。

Objective To investigate the patient visit delay among tuberculosis patients in Shenyang,and analyze the influencing factors in order to provide basis for development of improving measures.Methods This study mainly adopted the method of prospective data collection.From 2017 to 2018,all 205 inpatients who were diagnosed with tuberculosis and≥15 years old in the second department of tuberculosis in Tenth People’s Hospital of Shenyang City(Shenyang Chest Hospital),were investigated with questionnaires and their clinical data were recorded.Questionnaire survey and clinical data collection included general demographic characteristics(age,gender,body mass index,marital status,education level,floating population,drinking,smoking and insurance type),clinical characteristics(severity of the disease,primary treatment/retreatment,drug resistance,first diagnosing institution,whether paying clinical visit on symptoms,cavity exsistance,sputum smear test results)and knowledge of tuberculosis prevention and control(8 key knowledge about tuberculosis including main transmission route,suspicious symptoms,free policies and professional institutions for tuberculosis prevention and control).In this study,time interval from the date of tuberculosis symptoms onset to the date of first visit to clinical institution≥14 dwas set as the criteria for delay of visit.Chi-square test and multivariate logistic regression were used to analyze the influencing factors of the delay of visit.Results A total of 205 tuberculosis patients were investigated,among them 110 patients(53.7%)got visit delay.Multivariate logistic regression analysis showed that living far away from the hospital(OR(95%CI)=3.405(1.102-10.518)),mild illness(OR(95%CI)=12.384(3.558-43.109)),first time of treatment(OR(95%CI)=2.099(1.109-3.974))and drinking(OR(95%CI)=2.283(1.212-4.299))were factors affecting the visit delay.Conclusion The visit delay among Shenyang hospitalized TB patients is obvious,which is associated with living far away of the hospital,mild clinical symptoms,first time of treatment and drinking history.The education of tuberculosis relevant knowledge should be enhanced in general population.