关键词: 结核, 肺, 医师诊疗模式, 能力建设, 数据说明, 统计, 对比研究, 小地区分析

Abstract:

Objective To analyze the capacity building and diagnosis and treatment effect of implementation of the new tuberculosis prevention and management mode (new mode) in Shaanxi Province, and to provide suggestions regarding policy and measures for further prevention and control.Methods We analyzed the changes in tuberculosis system construction, capacity building, patient discovery, treatment and management index after implementing the new tuberculosis prevention and management mode in 10 prefecture-level cities and 108 counties (districts) in the province. Comparison in capacity building between 2014 and 2017 was conducted using the data derived from the “12th Five-Year Plan for Tuberculosis Prevention and Control in Shaanxi Province” and the joint inspection of tuberculosis prevention and treatment work in 2017. Comparisons in patient discovery and treatment management between the three years before implementation (2012-2014) and the three years after implementation (2015-2017) were conducted using the data derived from the “Tuberculosis Information Management System”. Statistical analysis was performed using SPSS 19.0. Chi-square test was used to compare the rate and ratio. P<0.05 was statistically significant.Results There were 20 and 107 designated tuberculosis hospitals in 2014 and 2017, respectively. The number of designated hospitals was increased by 87 in 2017 compared with 2014. In 2014, there were 923 tuberculosis control staff in the province, including 656 in the Centers for Disease Control and Prevention (CDC) and 267 in the designated hospitals. In 2017, there were 1200 tuberculosis control staff, including 403 in the CDC and 797 in the designated hospitals. Compared with 2014, staff in the CDC decreased by 38.57%, and staff in the designated hospital increased by 198.50%. In 2014, tuberculosis drug resistance molecular biology testing was carried out in 3 prefecture-level cities, molecular biology testing was carried out in 5.56% (6/108) counties (districts), and sputum culture was carried out in 12.04% (13/108) of counties (districts). In 2017, tuberculosis drug resistance molecular biology testing was carried out in 8 prefecture-level cities, molecular biology testing was carried out in 49.07% (53/108) counties (districts), and sputum culture was carried out in 55.56% (60/108) of counties (districts). In the three years before implementing the new mode, the sputum rate was 98.50% (329981/335014), 63 892 patients were reported with pulmonary tuberculosis (of whom, 4089 had tuberculous pleurisy), and 14087 patients were pathogenic positive with a positive rate of 23.56% (14087/59803). In the three years after implementing the new mode, the sputum rate was 95.00% (312503/328948), 61583 patients were reported with pulmonary tuberculosis (of whom, 5295 had tuberculous pleurisy), and 10588 patients were pathogenic positive with a positive rate of 18.81% (10588/56288). The sputum rate and pathogenic positive rate were decreased after the implementation of the new prevention and treatment mode (sputum rate: χ ²=6484.178, P=0.000; pathogenic positive rate: χ ²=390.104, P=0.000). Among all of the pulmonary tuberculosis cases, the ratio of symptomatic treatment was 29.43% (18805/63892) and 25.38% (15628/61583) before and after the implementation of the new mode, respectively. The ratio of transfer treatment of pulmonary tuberculosis was 43.90% (28047/63892) and 57.79% (35586/61583) before and after the implementation of the new mode, respectively. The ratio of patients from symptomatic treatment decreased (χ ²=259.002, P=0.000), and the ratio of patients from transfer treatment increased (χ ²=2419.762, P=0.000) after the implementation of the new mode. The overall arrival rates of reported patients or suspected patients were 93.18% (62177/66726) and 89.96% (61323/68169), respectively, which was decreased after implementation of the new mode (χ ²=453.550, P=0.000). The successful treatment rates of patients were 95.04% (60464/63619) and 94.97% (57872/60939) before and after implementing the new mode, respectively. There was no significant difference in successful treatment rate after implementing the new mode (χ ²=0.356, P=0.551). Conclusion The new tuberculosis prevention and control management model has been initially established and implementing well, and the prevention and control capacity has been strengthened in Shaanxi Province. However, some indexes of the diagnosis treatment management of patients have declined, and thus the quality of implementation needs to be improved.

Key words: Tuberculosis, pulmonary, Physician’s practice pattern;, Capacity building, Data interpretation, statistical, Comparative study, Small-area analysis