提高院内丙型肝炎转诊率、就诊率和治愈率的干预措施研究  

Study on hepatitis C intervention measures to improve the referral,treatment,and cure rate in hospitals

作　　者：程欢欢 蔡大川[2] Cheng Huanhuan;Cai Dachuan(Department of Infectious Diseases,Chongqing Red Cross Hospital(Jiangbei District People's Hospital),Chongqing 400020,China;Infectious Disease Department of the Second Affiliated Hospital of Chongqing Medical University,Institute for Viral Hepatitis,Chongqing Medical University,Chongqing 400010,China)

机构地区：[1]重庆市红十字会医院(江北区人民医院)感染科,重庆400020 [2]重庆医科大学附属第二医院感染病科,重庆医科大学病毒性肝炎研究所,重庆400010

出　　处：《中华肝脏病杂志》2024年第S2期38-43,共6页Chinese Journal of Hepatology

基　　金：重庆市科卫联合医学科研重点项目(2022ZDXM001)

摘　　要：目的通过干预措施的尝试探索丙型肝炎诊治管理流程,探讨院内丙型肝炎教育-筛查-诊治-随访全流程管理的必要性。方法以2019年11月至2020年11月重庆医科大学附属第二医院门诊及住院就诊患者中抗-HCV阳性者的HCV RNA检测情况、科室分布情况、请会诊情况、专科就诊情况及诊治情况为基线,在尝试分别针对患者和医生干预措施后再次分别统计分析院内就诊者中抗-HCV阳性者的HCV RNA检测情况、科室分布情况、请会诊情况、专科就诊情况及诊治情况。使用Pearson卡方检验评估差异。95%置信区间分别采用Wilson评分法和gamma分布法计算。结果经过干预措施后,院内关于丙型肝炎的就诊率、转诊率及诊治率并未得到明显的提高,与干预之前的数据相比差异均无统计学意义。结论由于缺乏标准、连贯、严格的丙型肝炎筛查、转诊和诊治院内全流程管理制度,绝大部分非感染病科和少数感染病科的抗-HCV阳性的患者没有得到及时的病情评估、转诊、确诊和治疗,进而导致丙型肝炎患者的漏检、漏诊和漏治。Objective To explore and discuss hepatitis C processes of diagnosis,treatment,and management through intervention measures as well as the necessity of whole management attempt in education,screening,diagnosis,treatment,and follow-up in hospitals.Method The baseline status of HCV RNA detection,departmental distribution,consultation requests,specialist visits,and diagnosis and treatment of anti-HCV positive patients who visited the outpatient and inpatient departments of the Infectious Diseases of the Second Affiliated Hospital of Chongqing Medical University from November 2019 to November 2020 was analyzed.Statistical analysis was re-conducted on the status of HCV RNA detection,departmental distribution,consultation requests,specialist visits,and treatment among anti-HCV positive patients following the implementation of intervention measures for patients and clinicians in the hospital.The differences were evaluated using the Pearson chi-square test.The Wilson score and the gamma distribution method were used to calculate the 95%confidence interval(95%CI).Results The rates of consultation,referral,diagnosis,and treatment did not increase significantly following the intervention in the hospital for hepatitis C,and there was no statistically significant difference compared with the data before the intervention.Conclusion The vast majority of anti-HCV-positive patients in non-infectious and a few infectious disease departments did not receive timely disease assessment,referral,diagnosis,and treatment because hospitals lacked a standard,consistent,and stringent whole management process for hepatitis C screening,thereby causing missed detection,diagnosis,and treatment.

关 键 词：丙型肝炎 患者转诊率 治愈率 诊断 治疗 

分 类 号：R512.6[医药卫生—内科学]