不同医疗机构合作模式对结核病患者发现影响的系统综述

doi:10.3969/j.issn.1000-6621.2014.12.011

摘要/Abstract

摘要： 目的系统回顾不同国家和地区实施不同医疗机构合作模式的效果及特点，描述不同合作模式对结核病发现的影响。方法由主题专家和检索人员讨论后确定检索词，共检索12个数据库3个卫生机构网站（世界卫生组织网、国家卫生和计划生育委员会及美国疾病预防控制中心）和搜索引擎Google Scholar，纳入发表于2000—2013年的所有描述或评价不同医疗机构合作［包括公立-私立机构合作、公立-公立合作即医防合作、非政府组织（NGO）-私立机构合作］、患者发现效果评价等关键词的文章的文献，共检索到803篇文章（排除观点性文章、信件、社论、评论、文献目录、会议摘要等），对符合条件的27篇文献进行分析。结果目前合作形式主要有3种：分别是公立机构-公立机构合作模式（医防合作），主要在我国实施，通过合作患者发现率提高了24.4%～50.1%不等；公立机构-私立机构合作，主要在印度、印度尼西亚、越南、肯尼亚、尼泊尔、韩国及美国等国家实施，通过合作患者发现率提高了7%～57%不等；非政府组织-私立机构合作，主要以印度为主，通过合作患者发现率提高了12%～40%不等。结论应进一步完善我国现有的医防合作模式，并将非政府组织及私立机构纳入医防合作体系中来，以提高我国肺结核患者发现的水平。

关键词: 结核/诊断, 合作行为, 卫生系统机构

Abstract: Objective Systematic review on impact of different international medical institutions mix model on tuberculosis case detection. Methods We determined the key words by experts’ discussion, and searched 12 database, 3 health agencies websites(World Health Organization network, National Health and Family Planning Commission of the People’s Republic of China and the United States Centers for Disease Control and Prevention) and Google Scholar. Our inclusion criteria were research papers that reported describing public-private, public-public (general hospital and TB dispensary) mix, Non-governmental organizations (NGO)-private mix, case detection, effect evaluation. Eight hundred and three studies (published in 2000-2013)were retrieved, except perspective-related articles, letters, news, editorials, reviews, bibliography and conference summary, 27 full-text studies were included and analyzed. Results The results showed that there are mainly 3 kinds of mixes: public-public (general hospital and TB dispensary) mix, which implement mainly in China, improved the case detection rate ranging from 24.4% to 50.1% through mix; Public-private mix, mainly in India, Indonesia, and Vietnam, Kenya, Nepal, South Korea and the United States and other countries, case detection rate increased 7%-57% through mix; Non-governmental organization-private mix, mainly in India, the case detection rate increased 12%-40% through mix. Conclusion We should further perfect the existing general hospital and TB dispensary mix in China, bring the non-governmental organizations and private institutions into general hospital and TB dispensary mix system, to improve the tuberculosis case detection in China.

Key words: Tuberculosis/diagnosis, Cooperative behavior, Health systems agencies

马艳，杜建，李亮，刘宇红. 不同医疗机构合作模式对结核病患者发现影响的系统综述[J]. 中国防痨杂志, 2014, 36(12): 1055-1061. doi: 10.3969/j.issn.1000-6621.2014.12.011

MA Yan, DU Jian, LI Liang, LIU Yu-hong. Systematic review on impact of different medical institutions mix model on tuberculosis case detection[J]. Chinese Journal of Antituberculosis, 2014, 36(12): 1055-1061. doi: 10.3969/j.issn.1000-6621.2014.12.011

参考文献

［1］Sudha G, Nirupa C, Rajasakthivel M, et al. Factors influencing the care-seeking behaviour of chest symptomatics: a communitybased study involving rural and urban population in Tamil Nadu,South India. Trop Med Int Health，2003，8(4): 336-341.
［2］曹艳林，刘久畅，王峰峰，等. 借鉴国际结核病防治立法经验, 推进我国结核病防治立法. 中国防痨杂志, 2009, 25(2):61-63.
［3］Arora VK, Sarin R, Lonnroth K. Feasibility and effectiveness of a public-private mix project for improved TB control in Delhi, India. Int J Tuberc Lung Dis, 2003,7(12):1131-1138.
［4］Newell JN, Pande SB, Bara SC, et al. Control of tuberculosis in an urban setting in Nepal: public-private partnership. Bull World Health Organ,2004, 82(2): 92-98.
［5］Munsiff SS, Ahuja SD, Li J, et al. Public-private collaboration for multidrug-resistant tuberculosis control in New York city. Int J Tuberc Lung Dis,2006,10(6):639-648.
［6］Varkey P, Harris S,Edmonson L, et al. An innovative model for tuberculosis control: an academic medical center-public health department partnership.Minn Med, 2010, 93(1): 39-41.
［7］Kumar MK, Dewan PK, Nair PK, et al.Improved tuberculosis case detection through public-private partnership and laboratory-based surveillance, Kannur District, Kerala, India, 2001―2002. Int J Tuberc Lung Dis, 2005, 9(8): 870-876.
［8］Quy HT, Lan NT, Lonnroth K, et al. Public-private mix for improved TB control in Ho Chi Minh City, Vietnam: An assessment of its impact on case detection. Int J Tuberc Lung Dis，2003, 7(5): 464-471.
［9］Maung M, Kluge H, Aye T, et al. Private GPs contribute to TB control in Myanmar: evaluation of a PPM initiative in Mandalay Division.Int J Tuberc Lung Dis,2006,10(9):982-987.
［10］Balasubramanian R, Rajeswari R, Vijayabhaskara RD, et al. A rural public-private partnership model in tuberculosis control in south India. Int J Tuberc Lung Dis, 2006, 10(12):1380-1385.
［11］Ahmed J, Ahmed M, Laghari A, et al. Public private mix model in enhancing tuberculosis case detection in District Thatta, Sindh, Pakistan.J Pak Med Assoc, 2009，59(2):82-86.
［12］Dewan PK,Lal SS,Lonnroth K, et al.Improving tuberculosis control through public-private collaboration in India: literature review. BMJ, 2006, 332(7541):574-578.
［13］Lonnroth K,Uplekar M, Arora VK, et al. Public-private mix for DOTS implementation: what makes it work. Bull World Health Organ，2004,82(8): 580-586.
［14］Krishnan A,Kapoor SK.Involvement of private practitioners in tuberculosis control in Ballabgarh, Northern India.Int J Tuberc Lung Dis，2006，10(3):264-269.
［15］Hamid Salim MA, Uplekar M, Daru P, et al. Turning liabi-lities into resources: informal village doctors and tuberculosis control in Bangladesh. Bull World Health Organ, 2006,84(6):479-484.
［16］Sehgal S, Dewan PK, Chauhan LS, et al. Public-Private Mix TB activities in Meerut, Uttar Pradesh, North India: delivering DOTS via collaboration with private providers and non-governmental organizations. Indian J Tuberc, 2007, 54(2): 79-83.
［17］Lal SS, Sahu S, Wares F, et al. Intensified scale-up of public-private mix: a systems approach to tuberculosis care and control in India. Int J Tuberc Lung Dis,2011,15(1):97-104.
［18］Ambe G,Lonnroth K,Dholakia Y,et al. Every provider counts:effect of acomprehensive public-private mix approach for TB control in a large metropolitan area in India. Int J Tuberc Lung Dis, 2005, 9(5): 562-568.
［19］方小平，黄玲，杨之怡. 结防机构与专科医院合作实施结核病防治规划的效果评价.中国热带医学,2008，8(2):188-189.
［20］吴方,俞丽娜,王华，等.通过加强结防机构与医院的合作提高肺结核病人发现效果分析. 中国防痨杂志,2007,29(1):37-40.
［21］李仁忠,李海涛,傅国荣. 结防机构与医院合作提高肺结核病患者发现研究. 预防医学情报杂志,2009,25(3):173-176.
［22］黄飞，王黎霞，成诗明，等. 医防合作对提高肺结核患者发现的影响. 中国防痨杂志,2010,32(7):361-365.
［23］王黎霞,成诗明,徐敏,等.加强结防机构与医院的合作提高肺结核病人发现试点报告. 中国防痨杂志,2007,29(6):479-482.
［24］王景红，杨建安. 结核病防治机构与综合性医疗机构合作对结核病控制工作的效果分析. 安徽医学,2010，31（7）:818-820.
［25］田福元,刘艳梅,刘剑学，等. 2009―2012年赤峰市非结核病防治机构网络直报肺结核或疑似肺结核患者转诊追踪及确诊情况分析. 中国防痨杂志,2014,36(1):37-40.
［26］吴志磊.山东省涂阳结核病人综合医院转诊情况分析. 实用预防医学,2003,10(6):935-936.
［27］刘勋,熊昌富,周丽平，等. 湖北省网络直报疑似肺结核病人转诊追踪工作分析.现代预防医学, 2007, 34(17): 3221-3224.
［28］李刚，赵春力，孙长江，等. 黑龙江省黑河市2009—2011年非结核病防治机构肺结核患者转诊与追踪情况分析. 中国防痨杂志,2013,35(3):198-200.
［29］李峻，刘小秋，李雪，等. 中国全球基金项目结核病定点医院模式实施评价. 中国防痨杂志,2013,35(10):778-782.
［30］Chauhan LS, Tonsing J. Revised national TB control programme in India. Tuberculosis (Edinb),2005,85(5/6):271-276.
［31］Xu L,Gai R,Wang X,et al. Socio-economic factors affecting the success of tuberculosis treatment in six counties of Shandong Province,China. Int J Tuberc Lung Dis， 2010,14(4):440-446.
［32］Floyd K, Arora VK, Murthy KJ, et al.Cost and cost-effectiveness of PPM-DOTS for tuberculosis control: evidence from India.Bull World Health Organ，2006,84(6):437-445.
［33］Ferroussier O, Kumar MK, Dewan PK, et al. Cost and cos-teffectiveness of a public-private mix project in Kannur District, Kerala, India, 2001—2002. Int J Tuberc Lung Dis，2007,11(7):755-761.
［34］Udwadia ZF,Pinto LM,Uplekar MW.Tuberculosis management by private practitioners in Mumbai, India：has anything changed in two decades? PLoS One,2010,5(8):e12023.
［35］全国第五次结核病流行病学抽样调查技术指导组, 全国第五次结核病流行病学抽样调查办公室. 2010年全国第五次结核病流行病学抽样调查报告. 中国防痨杂志,2012,34(8):485-508.
［36］严非. 中国结核病控制现状、问题与对策——社会评价案例研究. 上海：复旦大学,2007.
［37］中国疾病预防控制中心. 中国2009年疾病监测统计报告. 北京：中国疾病预防控制中心，2009.
［38］Vandan N, Ali M, Prasad R,et al.Assessment of doctors’ knowledge regarding tuberculosis management in Lucknow, India: a public-private sector comparison. Public Health, 2009,123(7)：484-489.
［39］Uplekar M, Pathania V, Raviglione M.Private practitioners and public health: weak links in tuberculosis control. Lancet, 2001，358（9285）:912-916.
［40］Xianyi C, Fengzeng Z, Hongjin D, et al. The DOTS strategy in China: results and lessons after 10 years. Bull World Health Organ, 2002，80(6):430-436.
［41］Hurtig AK, Pande SB, Baral SC, et al. Linking private and public sectors in tuberculosis treatment in Kathmandu Valley,Nepal. Health Policy Plan, 2002，17（1）: 78-89.
［42］中国疾病预防控制中心. 中国 2008 年疾病监测统计报告. 北京：中国疾病预防控制中心，2008.

[1]	周爽,张瑞,陈效友,阚晓宏,彭鹏,杜建. 结核病相关医疗机构医师受教育及在职学习满意度状况调查[J]. 中国防痨杂志, 2019, 41(7): 719-726.
[2]	王晓宁,何天伦,耿梦杰,宋渝丹,赵飞,何广学. 我国12省结核病门诊和实验室感染控制管理措施实施现状的抽样调查及其主成分分析[J]. 中国防痨杂志, 2018, 40(5): 519-524.
[3]	黄迪希，谭守勇，刘志辉. 蛋白质组学在结核性胸腔积液诊断中的现状及进展[J]. 中国防痨杂志, 2016, 38(3): 180-184.
[4]	方勇，肖和平. 潜伏性结核感染的诊治进展[J]. 中国防痨杂志, 2016, 38(2): 144-147.
[5]	何花，周玉皆，文高艳，王新宁，丁畅，曾谊. γ干扰素诱导蛋白10在结核病诊断与鉴别诊断中的价值[J]. 中国防痨杂志, 2015, 37(4): 393-396.
[6]	宋媛媛，郑惠文，赵雁林. 我国结核病实验室诊断进展历程[J]. 中国防痨杂志, 2014, 36(9): 764-768.
[7]	张立群，刘一典，朱友生，唐神结. 我国结核病临床诊治的回顾与展望[J]. 中国防痨杂志, 2014, 36(9): 769-773.
[8]	中国防痨协会结核病临床专业委员会. 结核病临床诊治进展年度报告（2013年）（第一部分结核病临床诊断）[J]. 中国防痨杂志, 2014, 36(8): 714-740.
[9]	蔡杏珊，马品云，张院良，谭耀驹. 实时荧光核酸恒温扩增检测技术在结核病诊断中的临床应用[J]. 中国防痨杂志, 2014, 36(6): 458-461.
[10]	李辉，谭耀驹，李洪敏，马晓光，邢进，郝宝林，赵雁林. 利福平耐药实时荧光定量核酸扩增检测技术的诊断效果对比研究[J]. 中国防痨杂志, 2014, 36(6): 472-476.
[11]	赵美芬，刘映霞，彭忠田，陈川铁，刘京，林益敏，陈建波. 检测外周血特异性结核分枝杆菌抗体对活动性结核病的诊断价值研究[J]. 中国防痨杂志, 2014, 36(5): 356-361.
[12]	蒋俊. 结核分枝杆菌感染T细胞斑点试验的质量控制与质量保证[J]. 中国防痨杂志, 2014, 36(5): 380-384.
[13]	张登才，刘斌，张丽华，史敏，苏勤军，杨艳丽，钱震，哈英娣. 抗酸染色在结核病病理诊断中的价值[J]. 中国防痨杂志, 2014, 36(4): 274-278.
[14]	葛燕萍，肖和平. γ干扰素释放试验与结核菌素皮肤试验辅助检测肺外结核病的比较[J]. 中国防痨杂志, 2014, 36(3): 194-197.
[15]	刘小秋姜世闻王黎霞屈燕. 2010年全国县（区）级结核病防治机构人员现状分析[J]. 中国防痨杂志, 2013, 35(6): 447-450.