新发涂阳肺结核患者就诊和诊断延误的影响因素研究  

Factors associated with patients' delay and diagnosis delay for patients with smear positive pulmonary tuberculosis

作　　者：王倪[1] 周林[1] 白丽琼[2] 许卫国[3] 何金戈[4] 成诗明[5] 

机构地区：[1]中国疾病预防控制中心结核病预防控制中心患者关怀部,北京102206 [2]湖南省结核病防治所结核病控制科 [3]江苏省疾病预防控制中心慢性传染病防制科 [4]四川省疾病预防控制中心结防所 [5]中国疾病预防控制中心结核病预防控制中心主任办公室,北京102206

出　　处：《中国防痨杂志》2012年第12期790-794,共5页Chinese Journal of Antituberculosis

基　　金：中国全球基金结核病项目实施性研究(08-009)

摘　　要：目的分析新发涂阳肺结核患者就诊和诊断延误的影响因素,为制定减少延误发生的干预措施提供科学依据。方法采取典型调查的方法,在东、中、西部各选择1个县作为研究现场,采用编制的《新发涂阳肺结核患者诊疗过程调查表》对研究现场结核病防治(简称"结防")机构2010年5—9月登记发现的329例初治涂阳肺结核患者全部进行了面对面的问卷调查,获得有效个案调查表329份。使用t检验比较就诊延误、诊断延误等不同指标间差异有无统计学意义,使用Cox比例风险回归模型分析影响患者就诊延误的因素,使用非参数检验比较不同医疗机构患者的发现和转诊延误。结果患者就诊延误15d(0～594d),诊断延误10d(0～429d),就诊延误与诊断延误的差异无统计学意义(t=1.596,P=0.111)。与自费相比较,有其他医疗保险(除外新农合)的患者就诊延误更短(β=0.701,Waldχ2=6.223,P=0.013,RR=2.015),有发热症状的患者更易就诊(β=0.430,Waldχ2=11.556,P=0.001,RR=1.537),而有咳嗽症状(β=-0.711,Waldχ2=9.314,P=0.002,RR=0.491)或咯痰症状(β=-0.429,Waldχ2=8.549,P=0.003,RR=0.651)的患者就诊延误更长。不同医疗机构发现结核病可疑者的能力差异有统计学意义(χ2=115.134,P=0.000),其中药店的延误时间最长(26d,四分位间距66.5d),县级及以上医院(0d,四分位间距0d)、乡镇卫生院(0d,四分位间距6d)和结防机构(0d,四分位间距0d)延误时间最短;不同医疗机构转诊结核病可疑者的能力上差异有统计学意义(χ2=55.476,P=0.000),其中结防机构延误时间最短(0d,四分位间距1d),个体诊所延误时间最长(9d,四分位间距19.5d)。结论新发涂阳肺结核患者的延误包括患者和医疗机构两方面的因素,其中缺乏对结核病可疑症状的相关知识或对症状不重视是导致患者延误的主要因素,而基层医疗机构结核病可疑者的发现和转诊延误是导致医疗机构延误的主要因素。Objective To analyze the factors associated with patients＇ delay and diagnosis delay for patients with smear positive pulmonary tuberculosis in order to provide evidence base for the formulation of relevant TB control and prevention strategies.Methods The typical survey methods were adopted and 3 counties were selected from the eastern,middle and western provinces each.New smear positive TB patients registered during May 2010 to September 2010 were administered face-to-face self-designed questionnaire survey,329 effective questionnaires were collected.t test was used for comparing the difference between patients＇ delay and diagnosis delay,Cox proportional hazards regression model was used for analyzing the factors associated with health seeking delay,and rank sum test was used for comparing the diagnosis delay between different facilities.Results Health seeking delay was 15d（0-594d） and diagnosis delay was 10d（0-429d）,there is no statistically significant difference between these two indicators（t=1.596,P=0.111）.Patients who had medical insurance（except for the new rural cooperative medical care）（β=0.701,Wald χ2=6.223,P=0.013,RR=2.015） or suffering from fever（β=0.430,Wald χ2=11.556,P=0.001,RR=1.537） are more likely to go hospitals quickly,but patients with symptom of cough（β=-0.711,Wald χ2=9.314,P=0.002,RR=0.491） or sputum（β=-0.429,Wald χ2=8.549,P=0.003,RR=0.651） are more likely to have a longer delay.For TB case detection,the delays vary caused by different medical institutions（χ2=115.134,P=0.000）,shortest in county hospital or above（0d,Q 0d）,township hospital（0d,Q 6d） and TB facilities（0d,Q 0d）,longest in pharmacy（26d,Q 66.5d）.And there are difference between medical institutions on TB patients＇ referral（χ2=55.476,P=0.000）,shortest in TB facilities（0d,Q 1d）,longest in individual private clinics（9d,Q 19.5d）.Conclusion The factors of delay for patients with smear positive pulmonary tuberculosis will be considered from patients and medi

关 键 词：结核 肺 诊断 误诊 转诊和会诊 

分 类 号：R521[医药卫生—内科学]