重庆市非结防机构网络直报肺结核疫情到位情况综合分析  

Analysis on the situation of direct reporting of tuberculosis patients of non-tuberculosis control institutions in Chongqing

作　　者：张文 刘英 吴成果 胡代玉 张娅 余雅 ZHANG Wen;LIU Ying;WU Cheng-guo;HU Dai-yu;ZHANG Ya;YU Ya(Chongqing Institute of Tuberculosis,Chongqing 400050,China)

机构地区：[1]重庆市结核病防治所

出　　处：《现代预防医学》2019年第16期3023-3027,共5页Modern Preventive Medicine

基　　金：重庆市卫生计生委医学科研项目(No.2017MSXM125)

摘　　要：目的分析重庆市非结防机构网络直报肺结核患者的总体到位情况,为制定相应对策,深化医防合作提供科学依据。方法以现住址为条件,对2017年重庆市非结防机构39 045例肺结核或疑似患者的转诊追踪情况进行综合分析评价。结果 2017年重庆市应转诊39 045例,转诊到位率35.6%(13 918/39 045),追踪到位率61.5%(14 668/23 860),总体到位率为76.5%(29 853/39 045);渝东北和渝东南片区的转诊到位情况明显低于主城区和渝西片区(P<0.001);渝东南片区的追踪到位和总体到位情况明显低于另外3个地区(P<0.001);本报本患者或疑似患者的转诊到位、追踪到位和总体到位均高于外报本(P<0.001),外省医疗机构和市级医疗机构均低于县级和乡镇级(P<0.001)。常住地位于渝西片区(OR=1.160;95%CI=1.081~1.245)、职业为学生或老师(OR=1.311;95%CI=1.072~1.603);报告类别为本报本(OR=1.351;95%CI=1.237~1.474)、医院类别为县级医疗机构(OR=4.264;95%CI=4.025~4.516)和乡镇级医疗机构(OR=11.421;95%CI=10.107~12.905)是影响患到位的保护因素。患者常住地位于渝东南片区(OR=0.399;95%CI=0.368~0.432)、医院类别为外省医疗机构(OR=0.457;95%CI=0.401~0.522)为影响到位的危险因素。结论重庆市非结防机构网络报告疑似肺结核患者总体到位水平不高,需采取加强归口管理宣传和技术指导、加大对临床医生的转诊考核等措施,以提高患者及时到定点医疗机构的比例,确保患者均能在定点医疗机构规范治疗。Objective We analyzed the situation of direct reporting of tuberculosis patients on the network of non-tuberculosis control institutions in Chongqing, in order to provide scientific basis for formulating corresponding countermeasures and deepen cooperation in medical defense. Methods Conducted on the current address, the 39,045 referral of TB patients and suspects from non-tuberculosis control institutions in Chongqing in 2017 have been evaluated. Results In the 39,045 referral of TB patients and suspects, the referral rate was 35.6%(13918/39045), the tracking rate was 61.5%(14668/23860), and the overall rate was 76.5%(29853/39045). The referral situation in the northeastern and southeastern regions of Chongqing was significantly lower than that in the main urban area and the western area of Chongqing(P<0.001). The tracking and overall rate in the southeastern region was significantly lower than that in other three regions(P<0.001). The referral, tracking and overall rate of local patients from local report or suspects was higher than local patient from nonlocal report(P<0.001). The referral, tracking and overall rate of other provinces and cities were lower than that of counties and towns(P< 0.001). The patients live in west/1 hour economic circle of Chongqing(OR=1.160;95%CI=1.081-1.245), student or teacher(OR=1.311;95%CI=1.072-1.603), local patients from local report(OR=1.351;95%CI=1.237-1.474), the hospital of county level(OR=4.264;95%CI=4.025-4.516) and township level(OR=11.421;95%CI=10.107-12.905) are the protective factors. The patients live in southeast(OR=0.399;95%CI=0.368-0.432) and other provinces(OR=0.457;95%CI=0.401-0.522) are the risk factors.Conclusion The overall rate of non-tuberculosis control institutions in Chongqing was not high. In order to improve the proportion of patients to seek medical advice in TB dispensary and ensure that every case of pulmonary tuberculosis can be registered in time, we should increase the publicity and technical guidance, and strengthen the examination of referrals.

关 键 词：肺结核 非结防机构 转诊追踪 分析评价 

分 类 号：R181.8[医药卫生—流行病学]