湖南省综合医院关于糖尿病患者中结核病筛查的问卷调查分析

Questionnaire survey analysis on the screening of tuberculosis among diabetic patients in general hospitals of Hunan Province

目的对湖南省不同等级的综合公立医院结核筛查相关检验检查开展情况及医院内直接参与糖尿病诊疗的医生对“在糖尿病患者人群中筛查结核病的意识及实践情况”进行调查,为符合我国国情的结核病-糖尿病联合防治活动计划的制定提供参考。方法根据结核病相关指南内容自行设计医院情况调查表和医生问卷表。采用分层抽样抽取湖南省公立综合三级医院14所、二级医院13所、一级及乡镇医院16所参与调查,邀请所抽取医院内所有直接参与糖尿病诊疗的医生参加现场医生知识问卷调查,问卷调查形式为匿名,当场交卷,不得查阅书刊和互相讨论。研究运用SPSS 22.0统计软件分析数据,各级医院间的结核筛查检验检查普及率通过χ²检验比较,采用logistrc回归分析影响医生筛查意识的相关因素,P≤0.05认为差异有统计学意义。结果(1)各级医院结核筛查相关检验检查开展情况:数字化X射线摄影胸片、结核菌素皮肤试验、痰涂片抗酸染色、痰分枝杆菌培养、γ干扰素释放试验的医院总普及率分别为90.7%(39/43)、72.1%(31/43)、55.8%(24/43)、34.9%(15/43)、27.9%(12/43),在三级、二级、一级及乡镇医院各自的普及率三组比较差异均有统计学意义(均P<0.05)。(2)62.5%(173/277)的医生具有首诊主动筛查意识,多因素分析发现“职称、工作年限”是主要影响因素;173名医生具有定期筛查意识,多因素分析发现“学历、接诊患者数目”是主要影响因素。(3)在实际临床中接诊糖尿病患者时,197名医生选择了“视情况定(患者有疑似症状或者相关检查结果怀疑结核时筛查)”,医生认为糖尿病患者没接受结核筛查的可能原因是“患者拒绝”行相关检验检查(76.5%,212/277)、“患者无相关主诉症状,没必要进行结核病筛查”(46.9%,130/277)、“本医疗机构尚未开展相关检验检查”(35.7%,99/277)。结论尽管直接参与糖尿病诊疗的医生们对于结核病相关知识有一定的了解,大部分医生的主动筛查意识比较强,但实际临床工作中的主动筛查率非常低,可能与医生没有相关指南指导及约束、患者沟通及动员不到位、医疗机构没有开展相应检验检查等多重因素相关。

Objective To investigate the development of tuberculosis screening-related tests in general public hospitals(GPHs)of different levels in Hunan Province and the"awareness and practice of screening tuberculosis in diabetic patients"by doctors directly involved in diabetes diagnosis and treatment in the hospitals,aiming to provide reference for the formulation of the tuberculosis-diabetes joint prevention and control activity plan based on our national conditions.Methods Stratified sampling was used to select 43 GPHs at three different levels in Hunan province:14 tertiary GPHs,13 secondary GPHs,and 16 primary GPHs.284 endocrinologists working in enrolled hospitals were invited to participate in the on-site questionnaire-survey and 277 qualified.The study used SPSS 22.0 statistical software to analyze the data.The prevalence rate of tuberculosis screening test among hospitals at all levels was compared by chi-square test,and logistic regression was used to analyze the related factors affecting doctors′screening awareness.P≤0.05 was considered statistically significant.Results The allocation of digital X-ray cameras,tuberculin skin tests,sputum acid-fast bacillus smears,sputum cultures for Mycobacterium tuberculosis,and interferon-gamma release assays in the 43 GPHs were 90.7%(39/43),72.1%(31/43),55.8%(24/43),34.9%(15/43),27.9%(12/43)with significant differences between the different hospital levels(P<0.05).173 endocrinologists considered it necessary to proactively initiate tuberculosis screening for patients at first diagnosis.When admitting patients,197 endocrinologists chose tuberculosis screening only for diabetes mellitus patients with suspected tuberculosis symptoms.The most possible reasons why diabetes mellitus patients wouldn′t undergo tuberculosis screening were"patients refused(76.5%,212/277)","patients didn′t complain of the symptom(46.9%,130/277)",and"tuberculosis screening-related tests haven′t been conducted in the hospital(35.7%,99/277)".Conclusions Although endocrinologists displayed some tuberculosis-related knowledge and awareness of the need for proactive tuberculosis screening,the actual screening rate in the clinical setting was low.This may be related to multiple factors,including those of patients,doctors,and medical institutions.