利用村医推荐疑似病人提高新涂阳肺结核病人发现率的研究  

Study on Increasing NSP Case-finding through Referring TB Suspects by Village Doctor

作　　者：周丽平[1] 熊昌富[1] 张险峰[1] 叶建君[1] 李国明[1] 刘勋[1] 肖爱清[1] 王小靖[1] 李爱国[1] 

机构地区：[1]湖北省疾病预防控制中心,武汉430079

出　　处：《中国预防医学杂志》2007年第1期1-4,共4页Chinese Preventive Medicine

基　　金：加拿大国际发展部资助项目(2004-fid-4-010)

摘　　要：目的分析利用村医集中推荐疑似病人到县结核病防治中心检查,提高新涂阳肺结核病人发现率研究的实施效果。方法2004年11月1日至2005年10月31日,在30个县登记肺结核可疑症状者,其资料经过审核、汇总,采用χ2检验对计数资料进行统计分析,处理过程通过SAS 8.1实现。结果项目期间30个单位共登记肺结核可疑症状者43 464例,肺结核可疑症状者就诊率1.8‰,其中村医推荐就诊率为0.6‰,病人自己求诊就诊率为1.2‰。项目实施前后比较肺结核可疑症状者就诊率提高了28.5%。前后推荐就诊率,总就诊率差异有统计学意义;自己就诊率差异无统计学意义。查痰率由58.7%提高到70.7%,新涂阳登记率由项目实施前的36.2/10万,提高到49.9/10万,新涂阳病人发现率由64.6%提高到86.0%。县结防科、综合医院、乡镇卫生院项目前后比较,疑似肺结核病人就诊及病人发现差异有统计学意义。县结防科对传染病网络直报病人的追踪率为70.9%,追踪到位率仅33.1%。结论利用村医集中推荐肺结核可疑症状者到县结防机构检查,同时运用在乡镇卫生院和综合医院设立结核病痰检点及加强网络直报病人追踪等措施,是提高新涂阳肺结核病人发现率的有效方法。Objective To analyze the effect of increasing new smcar positive （NSP） case - finding through referring tubereulesis （TB） suspects to county level dispensary village doctor. Methods From Nov. 1, 2004 to Oct.31, 2005, in 30 Counties which implemented FIDELIS （Fund for Innovative DOTS Expansion through Local Initiatives to Stop TB） project, the trained village doctors first found out the real situation of the TB suspects, then transferred them to county TB dispensaries or township/general hospital smcar microscopy sites to receive free related examination.Allowance were provided to the village doctors and the microscopists.TB suspects who didn＇ t arrive to TB dispensaries after referral was traced.The collected data analyzed by SAS 8.1 software, and X^2 testing was used for enumeration data. Results 43 464 suspected patients had been enrolled in 30 county dispensaries where the FIDELIS project was implemented, consulting rate was 1.8%o.Recommendation consulting rote by village doctors was 0.6%0 and self- consulting rate was 1.2‰. After project implementation, comulting rate of TB suspects was increased by 28.5% .There was significant difference on total comulting rate and recommendation rate, but no difference on self- consulting rate.Sputum examination rate increased from 58.7% to 70.7%; new mtear positive （NSP） registered rate from 36.2/10 000 to 49.9/100 000 and NSP detection rate from 64.6% to 86.0% .Consulting situation and case finding in TB dispensaries, general hospitals and township smear micrescopy sites had significant differences since project implementation.Tracing rate of TB dispensaries was 70.9%, and arrival rate due to tracing was only 33.1%. Conclusion Recommending TB suspects to TB dispensaries, establishing township/general hospital smear microscopy sites and strengthening direct network reported case tracing were effective measures to increase NSP detection rate.The study showed FIDELIS were successfully implemented and practicable.But, ff we want to bring the smear microsc

关 键 词：结核 肺 病例发现 集中推荐 

分 类 号：R521[医药卫生—内科学]