四川省贫困地区60岁及以上老年结核病患者救助效果分析  

Analysis on the Effect of Care Services for Elderly Tuberculosis Patients in Poverty-Stricken Areas in Sichuan Province

作　　者：夏岚[1] 仲玲 赵琴 田辉 饶正远[1] 袁正华 吴婷 杨春梅 康发扬 樊海英 成诗明 吴建林[1] XIA Lan;ZHONG Ling;ZHAO Qin;TIAN Hui;RAO Zhengyuan;YUAN Zhenghua;WU Ting;YANG Chunmei;KANG Fayang;FAN Haiying;CHENG Shiming;WU Jianlin(Sichuan Center for Disease Control and Prevention,Chengdu 610041,Sichuan Province,China;General Office of Sichuan Antituberculosis Association,Chengdu 610041,Sichuan Province,China;Department of Tuberculosis Prevention and Treatment,Qingchuan Center for Disease Control and Prevention,Qingchuan 628100,Sichuan Province,China;Department of Tuberculosis Prevention and Treatment,Jian'ge Center for Disease Control and Prevention,Qingchuan 628300,Sichuan Province,China;Department of Major Communicable Diseases,Guangyuan Center for Disease Control and Prevention, Guangyuan 628000,Sichuan Province,China;Secretariat of Chinese Antituberculosis Association,Beijing 100000,China)

机构地区：[1]四川省疾病预防控制中心,成都610041 [2]四川省防痨协会办公室,成都610041 [3]青川县疾病预防控制中心,四川青川628100 [4]剑阁县疾病预防控制中心,四川剑阁628300 [5]广元市疾病预防控制中心,四川广元628000 [6]中国防痨协会秘书处,北京100000

出　　处：《预防医学情报杂志》2019年第5期413-418,共6页Journal of Preventive Medicine Information

基　　金：中央财政支持社会组织参与社会服务项目(项目编号:2017B098)

摘　　要：目的评价四川省青川县和剑阁县实施的贫困地区老年结核病患者关怀服务项目(简称"项目")实施效果,探索贫困地区开展老年肺结核患者发现、治疗及管理工作的新模式。方法 2016-07/2017-11期间对两县≥60岁老年人口126 288名进行肺结核可疑症状调查和数字化X线摄影术(digital radiography,DR)检查,对可疑症状者和(或)数字化X线摄影术(digital radiography,DR)检查异常者收集痰标本开展痰涂片检查。对确诊并符合救助条件的158例老年肺结核患者开展关怀救助。利用SPSS 19.0软件进行统计分析,二分类变量及无序多分类变量使用卡方检验,有序分类变量比较采用非参数检验,以P<0.05为差异有统计学意义。结果两县2016-2017年主动症状筛查≥60岁的老年人筛查率为99.94%(126 288/126 367),肺结核病检查可疑症状者1.5万名,发现≥60岁老年肺结核病患者433例,报告发病率为171.33/10万(433/252 734),与2014-2015年的86.78/10万(220/253 506)比较差异有统计学意义(χ~2=89.15,P<0.05)。2016-2017年,两县登记的≥60岁的老年肺结核病患者从出现症状到就诊的平均时间从2014-2015年的68.72 d,缩短到29.93 d;老年肺结核病患者中病灶侵犯3个肺野以上及有空洞的患者数占所有老年人患者数的比例从2014-2015年的65.91%(132/220)减少到29.11%(126/433);两县受助的老年结核患者药物不良反应发生率比非受助老年结核患者减少了5.44%;两县受助的贫困老年肺结核患者自付治疗费用从0.17万元减少到0元。结论在贫困地区老年人中开展主动筛查大大提高了结核病发现率,同时缩短了就诊延迟时间,项目实施减轻了贫困老年患者经济负担。Objective To evaluate the effect of the care service project for elderly patients with tuberculosis in poverty-stricken areas implemented in Qingchuan County and Jian’ge County of Sichuan Province and explore a new model for the early detection, treatment and management of patients with tuberculosis in poverty-stricken areas. Methods Between July 2016 and November2017,126 288 people in the two counties were investigated for suspicious symptoms of tuberculosis and examined by DR, while sputum smears and sputum culture were collected from suspicious patients and/or those with abnormal DR results. Care assistance was provided to 158 elderly tuberculosis patients diagnosed and qualified for assistance. Statistical analysis was performed using SPSS 19.0 software;chi-square test was used for comparison of binomial categorical variables and unordered multinomial categorical variables,and non-parametric test for ordered categorical variables,with P<0.05 as the level of significance for differences. Results The screening rate of the elderly having received active symptom screening(≥60 years old) was 99.94%(126 288/126 367) in the two counties;15 000 people with suspicious symptoms were examined for tuberculosis, and 433 tuberculosis patients>60 years of age were found. The reported incidence rate was 171.33/105(433/252 734)in 2016 to 2017 and significantly different from that in 2014 to 2015[86.78/105(220/253 506)](χ^2=89.15,P<0.05). During the implementation of the project,the average time between presence of symptoms to consultation in elderly tuberculosis patients registered in the two counties was shortened from 68.72 d in 2014 to 2015 to 29.93 d. The proportion of elderly tuberculosis patients with lesions in more than three lung fields and cavities in all elderly patients decreased from65.91%(132/220) in 2014 to 2015 to 29.11%(126/433). The incidence of adverse drug reactions was decreased by 5.44% in the two counties as compared with the non-assisted elderly TB patients;the out-of-pocket treatment cost of poor

关 键 词：结核 肺 老年人 贫困 老年人保健服务 结果与过程评价(卫生保健) 

分 类 号：R521[医药卫生—内科学] R181[医药卫生—临床医学]