“十三五”期间广州市不同结核病防治管理模式实施效果评价

Evaluation on the implementation effect of different tuberculosis prevention and control management models during the 13th Five-Year Plan period in Guangzhou

目的:评价广州市现存结核病管理模式的实施效果,为不断完善结核病防治服务体系提供依据和实例。方法:从广州市结核病监测信息报告管理系统和广州市“十三五”结核病防治规划终期评估报告中搜集2016-2020年广州市4种结核病防治管理模式(慢病管理模式、“三位一体”模式、综合医院管理模式和委托服务模式)下的结核病疫情资料,计算不同模式下的肺结核患者登记率、病原学阳性率、治疗成功率、管理率和规范管理率等,并进行实施效果的成本-效用分析。结果:2016-2020年,广州市肺结核年均总登记率为51.78/10万(46 228/89 280 200),4种模式年均登记率由高及低依次为委托服务模式[74.37/10万(10 522/14 148 900)]、“三位一体”模式[50.17/10万(11 349/22 619 500)]、慢病管理模式[47.37/10万(14 588/30 793 700)]和综合医院管理模式[44.98/10万(9769/21 718 100)],差异有统计学意义(χ^(2)=222.422,P<0.001)。总病原学阳性率为49.33%(22 806/46 228),以慢病管理模式为最高[50.98%(7437/14 588)],委托服务模式为最低[48.07%(5058/10 522)];总治疗成功率为93.26%(43 113/46 228),以综合医院管理模式为最高[95.73%(9352/9769)],“三位一体”模式为最低[90.30%(10 248/11 349)];总规范管理率为89.08%(13 254/14 879),以委托服务模式为最高[95.40%(2573/2697)],“三位一体”模式为最低[82.69%(3100/3749)];差异均有统计学意义(χ^(2)=27.302,P<0.001;χ^(2)=306.666,P<0.001;χ^(2)=294.272,P<0.001)。总人均投入0.86元(76 477 200/89 280 200),挽回1个伤残调整生命年(DALY)损失需要投入的费用以“三位一体”模式为最高[188.20元(20 326 600/108 003.67)],综合医院管理模式为最低[153.77元(15 155 800/98 560.73)]。结论:“十三五”期间广州市4种结核病防治管理模式各有其优势及不足,未来仍需结合各区需求导向,从政府部门、系统到人才建设,积极采取措施,完善其现存结核病防治服务体系中的不足,以进一步提升患者登记率、病原学阳性率和总规范管理率。

Objective:To evaluate the implementation effect of the existing tuberculosis management mode in Guangzhou,and to provide the evidence and examples for improving the tuberculosis prevention and control service system.Methods:From 2016 to 2020,the tuberculosis epidemic data under four tuberculosis prevention and control management models(chronic disease management model,“trinity”model,general hospital management model and entrusted service mode)in Guangzhou were collected from the tuberculosis surveillance information reporting management system of Guangzhou and the final evaluation report of the 13th Five-Year Plan for tuberculosis prevention and control in Guangzhou.The registration rate,etiological positive rate,successful treatment rate,management rate and standardized management rate of pulmonary tuberculosis patients under different modes were calculated,and the cost-effectiveness analysis of the implementation effect was carried out.Results:In 2016—2020,the average annual registration rate of tuberculosis in Guangzhou was 51.78/100000(46228/89280200),the average annual registration rate of the four models from high to low,was entrusted service mode(74.37/100000(10522/14148900)),“trinity”(50.17/100000(11349/22619500)),chronic disease management(47.37/100000(14588/30793700))and general hospital management(44.98/100000(9769/21718100)),statistically significant difference(χ^(2)=222.422,P<0.001).The total etiological positive rate was 49.33%(22806/46228),the rate of chronic disease management model was the highest(50.98%(7437/14588)),and the entrusted service model was the lowest(48.07%(5058/10522));the overall treatment success rate was 93.26%(43113/46228),the rate of general hospital management model was the highest(95.73%(9352/9769)),and the“trinity”model was the lowest(90.30%(10248/11349));the total standard management rate was 89.08%(13254/14879),the rate of entrusted service mode was the highest(95.40%(2573/2697)),and the“trinity”model was the lowest(82.69%(3100/3749));the differences were statistically significant(χ^(2)=27.302,P<0.001;χ^(2)=306.666,P<0.001;χ^(2)=294.272,P<0.001).The per capita investment was 0.86 yuan(76477200/89280200),the maximum investment for one DALY loss was the“trinity”model(RMB 188.20 yuan(20326600/108003.67)),and the general hospital management model is the lowest(153.77 yuan(15155800/98560.73)).Conclusion:During the period,the four tuberculosis control management models in Guangzhou have its own advantages and disadvantages.In the future,it is still necessary to take active measures to improve the deficiencies in the existing tuberculosis prevention and control service system based on the demand orientation of various districts,from government departments,systems to talent construction,so as to further improve the patient registration rate,the etiological positive rate and the total standardized management rate.