关键词: 结核, 医师诊疗模式, 试点项目, 评价研究

Abstract:

Objective The aim of this study was to analyze the construction situation of tuberculosis prevention and control ability and the administrative situation of patient discovery and treatment after the implementation of pilot work of grading diagnosis and treatment and comprehensive prevention service model in Futian District, Shenzhen from 2017 to 2018, and then evaluate the effect of pilot work in Futian District.Methods The data after the implementation of pilot work of grading diagnosis and treatment and comprehensive prevention service model in Futian District from 2017 to 2018, including policy system established by Futian District, construction of tuberculosis prevention and treatment system, application of new diagnostic technology for tuberculosis, new management model for tuberculosis patients, were collected, and then compared with the data before the implementation of pilot work (from 2015 to 2016). Chronic Disease Prevention and Treatment Center in Futian District received 2093 suspected tuberculosis patients and 772 registered tuberculosis patients from 2015 to 2016; and received 2319 suspected tuberculosis patients and 690 registered tuberculosis patients from 2017 to 2018.Results In 2017, an assessment and funding allocation plan was formulated by Futian District and GeneXpert MTB/RIF rapid detection technology began to be enabled, and then remote video surveillance of Internet + DOT and home isolation measures for ordinary patients with smear-positive pulmonary tuberculosis were carried out. In 2018, the insured patients with tuberculosis (including multidrug-resistant tuberculosis) who admitted to specialist outpatient began to enjoy medical insurance of outpatient treatment for serious illness. From 2017 to 2018, the rate of active tuberculosis patients who treated in designated medical institutions was 82.43% (962/1167), the pathogenic diagnosis rate of patients with tuberculosis was 54.93% (379/690), the sputum culture rate of patients with tuberculosis was 94.49%, (652/690), the sputum culture detection rate of suspicious symptoms and suspected patients with tuberculosis was 89.00% (2064/2319), and the referral rate of patients with suspected tuberculosis reported by non-tuberculosis control institutions in the jurisdiction was 58.19% (1893/3253), which were significantly higher than those (72.35% (772/1067), 44.69% (345/772), 53.89% (416/772), 86.67% (1814/2093), and 52.17% (2199/4215)) from 2015 to 2016, respectively, with statistically significant differences (χ ²=32.61, 15.28, 305.17, 5.63, and 26.88, P=0.000, 0.000, 0.000, 0.020, and 0.000). From 2017 to 2018, the screening rate of tuberculosis by bacteriological examination in close contacts of positive patients was 100.00% (1128/1128), and the success rate of treatment for patients with tuberculosis was 95.24% (480/504); from 2015 to 2016, the screening rate of tuberculosis by bacteriological examination in close contacts of positive patients was 100.00% (1078/1078), and the success rate of treatment for patients with tuberculosis was 94.45% (698/739), which was both maintained at a high level. There was no statistically significant difference in the success rate of treatment (χ ²=0.37, P=0.540). Conclusion The implementation of pilot work of grading diagnosis and treatment and comprehensive prevention service model achieves favorable effects in Futian District, which can be promoted and further optimized.

Key words: Tuberculosis, Physician’s practice patterns;, Pilot projects, Evaluation studies