新疆喀什地区肺结核及疑似患者转诊未到位影响因素的分析  

Analysis on impacting factors on the failures in referring suspected TB patients reported and referred in Kashi Prefecture of Xinjiang Uygur autonomous region

作　　者：刘方梅[1] 顾晓明[1] 杨津明[1] 刘年强[1] 依帕尔[1] 玛依夏提[1] 吴卫东[1] 

机构地区：[1]新疆维吾尔自治区疾病预防控制中心结核病防治中心,乌鲁木齐830002

出　　处：《中国防痨杂志》2013年第1期54-59,共6页Chinese Journal of Antituberculosis

摘　　要：目的探讨新疆喀什地区综合医疗机构与结核病防治机构合作(简称"医防合作")过程中肺结核患者和可疑患者转诊不到位的原因及影响因素。方法2010年5—7月在喀什地区喀什市、英吉沙县2个地区,经过国家卫生部专家调研分析后,协助新疆维吾尔自治区制定统一调查方案,采取分组随机选择的方法,对60例到位与60例不到位疑似肺结核患者,进行问卷调查。两组调查问卷根据方案均由国家统一设计,内容一致,共调查120例(60例到位,60例不到位),有效回答问卷120例。调查者由经统一培训的结防专业人员共同完成。并由自治区CDC结核病防治人员对被调查对象及每张问卷内容进行审对。统计方法采用直接描述法和单因素、多因素logis-tic分析方法,采用SPSS 16.0进行分析。结果单因素logistic回归模型分析结果显示:到位组中认为自己服药能治愈肺结核的有18例、认为不能治愈的有39例、没考虑的3例;未到位组中认为自己能治愈肺结核有22例、认为不能治愈的有26例、没考虑的12例(OR=1.223,95%CI值为0.700～2.138,Waldχ2=8.40,P=0.015);在到位组中转诊医生告知国家结核病免费诊疗政策的有48例、未告知12例,在未到位组中告知37例、未告知23例(OR=2.486,95%CI值为1.096～5.641,Waldχ2=4.88,P=0.027)。多因素logistic回归模型分析结果显示:认为自己服药不能治愈肺结核(β=-1.871,Waldχ2=7.069,P=0.008,OR=0.154,95%CI值为0.039～0.612)和转诊医生告知国家结核病免费诊疗政策是肺结核患者在非结核病防治机构转诊不到位的影响因素(β=0.886,Waldχ2=4.000,P=0.045,OR=2.424,95%CI值为1.018～5.774)。结论喀什地区网络报告肺结核疑似患者不到位的原因在于综合医疗机构的医务人员没有对患者进行耐心、细致的结核病健康教育,使患者对结核病的认识有很多误区而不愿去结核病防治机构就诊,从而导致喀什地区网络报告疑似肺结核�Objective To explore the causes and influencing factors on TB patients and suspected patients who had been referred, but did not arrive at TB control institute with the implementation of medical-prevention cooperation, and to provide evidence for overall arrival rate improvement and appropriate policies and measures development. Methods In the period May to July 2010, a questionnaire survey of suspected TB patients, including 60 arrived and 60 non-arrived patients, was conducted with standard investigation plan in Kashi city and Yingjisha county. The questionnaire was developed by National Center for TB Control and Prevention （NCTB）, China CDC according to the investigation plan. The trained investigators interviewed 120 TB patients or suspected TB patients, and each questionnaire was checked by staff from CDC at autonomous region. Description, univariate analysis and multivariate analysis were used. Results Univariate analysis showed： by self-administered medication, 18 cases thought they could be cured, 39 didn＇t think so in arrival group, while the numbers in non-arrival group were 22 and 26 respectively （OR=I. 223, 95%CI=0. 700-2. 138, Wald χ^2 =8. 40, P=0. 015）. 48 cases and 37 cases were informed the national free policy on TB in arrival and non-arrival group respectively （OR= 2. 486, 95%CI=1. 096--5. 641, Wald χ^2 = 4. 88, P= O. 027）. Multivariate logistic regression analysis revealed that the patients who thought they could be cured by self-administered medication （β=- 1. 871, Wald χ^2= 7. 069, P = 0. 008, OR =0.154, 95 %CI= O. 039--0. 612） and those who were informed by the referring doctors of national free policy on TB （β=0. 886, Wald χ^2 =4. 000, P=0. 045, 0R=2. 424, 95GCI=1. 018-5. 774） were influencing factors on arriving at TB dispensaries referred by non-TB control institutions. Conclusion The health care workers should conduct TB health education activities patiently and carefully to avoid misunderstanding of TB, in order to improve referral arrival rate of TB patien

关 键 词：结核 肺 转诊和会诊 社区网络 因素分析 统计学 新疆[维吾尔自治区] 

分 类 号：R521[医药卫生—内科学]