湖南省结核病防治服务体系转型前后工作质量对比分析

Comparision of the work quality before and after reformation of tuberculosis control and prevention service system in Hu’nan Province

目的通过对湖南省结核病防治服务体系转型前后的工作质量进行比较分析,为完善我国结核病防治服务体系建设提供参考。方法选择进行新型结核病防治服务体系转型前后的湖南省14个市(州)131个县(市、区)作为研究对象,从中国疾病预防控制中心《结核病信息管理系统》中收集湖南省转型前3年(2014—2016年)、转型期2年(2017—2018年)与转型后1年(2019年)肺结核患者登记发病率、因症就诊率等15个指标的完成情况来评估新型结核病防治服务体系模式在患者发现与转诊、诊断与实验室检测、治疗与管理等方面的效果,采用SPSS 17.0软件对转型前后各工作指标结果的差异进行χ^(2)检验,以P<0.05为差异有统计学意义。结果转型前涂阳患者占活动性肺结核患者的比率、因症就诊率、病原学阳性率、高危人群耐药筛查率、疑似肺结核患者到位后排除率、利福平耐药患者纳入治疗率分别为38.47%(62759/163147)、38.44%(62782/163330)、39.00%(62759/160938)、40.95%(3919/9570)、54.47%(97246/178526)和55.96%(906/1619);转型后涂阳患者占活动性肺结核患者的比率、因症就诊率、病原学阳性率、高危人群耐药筛查率、疑似肺结核患者到位后排除率、利福平耐药患者纳入治疗率分别为45.33%(24680/54449)、22.21%(12114/54543)、46.44%(24680/53144)、78.45%(2341/2984)、44.63%(31161/69813)和64.55%(477/739);转型后这几个指标的工作质量均较转型前有所提升,且差异均有统计学意义(χ^(2)值分别为524.584、3395.102、604.545、897.304、1123.304和9.739;P值分别为0.000、0.000、0.000、0.000、0.000和0.002)。转型前肺结核患者登记发病率、初诊查痰率、活动性肺结核患者2或3个月末未痰检率、新涂阳患者治愈率和涂阳患者2或3个月末痰涂片阴转率分别为80.84/10万(163330/20203.22万)、94.74%(536808/566601)、1.64%(1033/62805)、92.35%(58511/63357)和98.11%(61620/62805);转型后肺结核患者登记发病率、初诊查痰率、活动性肺结核患者2或3个月末未痰检率、新涂阳患者治愈率和涂阳患者2或3个月末痰涂片阴转率分别为79.06/10万(54543/6898.77万)、92.60%(161429/174329)、4.36%(863/19776)、87.17%(15519/17803)和95.16%(18819/19776);这几个指标的工作质量均在转型后有所下滑,且差异均有统计学意义(χ^(2)值分别为7.718、75.790、26.658、287.790和59.985;P值分别为0.005、0.000、0.000、0.000和0.000)。结论新型结核病防治服务体系实施后部分工作质量得到提升,但肺结核患者登记发病率、初诊查痰率等指标出现下滑,应对下滑的指标给予关注。

Objective To provide reference for improving the construction of new type of tuberculosis(TB control and prevention service system by comparing the working quality before and after reformation in Hunan Province.Methods A total of 131 counties/districts in 14 cities/states of Hu’nan Province before and after reformation were selected,15 indexes such as the registration rate of tuberculosis,clinic visit rate due to symptoms and so on were collected from"China Information System for Disease Control and Prevention"to describe and compare case detection,referral and diagnosis,laboratory examination,treatment and management of TB patients in Hunan Province before(2014-2016),during(2017-2018)and after(2019)reformation.Chi-square test was used to analyze the differences before and after reformation by SPSS 17.0,P<0.05 was considered statistically significant.Results Before reformation,the rate of smear-positive PTB patients in active PTB patients,clinic visit rate due to symptoms,pathogenic positive rate,the drug resistance screening rate in high-risk population,exclusion rate of suspected patients after confirming,treatment enrolled rate of rifampicin-resistant patients were 38.47%(62759/163147),38.44%(62782/163330),39.00%(62759/160938),40.95%(3919/9570),54.47%(97246/178526)and 55.96%(906/1619),respectively.And those indexes were 45.33%(24680/54449),22.21%(12114/54543),46.44%(24680/53144),78.45%(2341/2984),44.63%(31161/69813),64.55%(477/739),respectively after reformation.The work quality of those indexes were significantly improved after reformation(χ^(2)=524.584,P=0.000;χ^(2)=3395.102,P=0.000;χ^(2)=604.545,P=0.000;χ^(2)=897.304,P=0.000;χ^(2)=1123.304,P=0.000;χ^(2)=9.739,P=0.002).Before reformation,the registration rate of tuberculosis,rate of sputum test in initial patients,rate of non-sputum test in active PTB patients at the end of 2 or3 months,cure rate of new smear-positive TB patients,sputum negative conversion rate after 2-or 3-month treatment in smear-positive PTB patients were 80.84/100000(163330/202032200),94.74%(536808/566601),1.64%(1033/62805),92.35%(58511/63357)and 98.11%(61620/62805),respectively;and those indexes were 79.06/100000(54543/68987700),92.60%(161429/174329),4.36%(863/19776),87.17%(15519/17803)and 95.16%(18819/19776),respectively after reformation.The working quality of those indexes were significantly declined after reformation(χ^(2)=7.718,P=0.005;χ^(2)=75.790,P=0.000;χ^(2)=26.658,P=0.000;χ^(2)=287.790,P=0.000;χ^(2)=59.985,P=0.000).Conclusion Part of the working quality has been steadily improved after reformation,however,we should pay attention to those declined indexes,such as the registration rate of tuberculosis,the rate of sputum examination in initial patients and so on.