关键词: 结核, 医师诊疗模式, 试点项目, 评价研究, 小地区分析

Abstract:

Objective To summarize the experience of the pilot of hierarchical diagnosis and treatment and comprehensive prevention and control service model of tuberculosis and evaluate the effectiveness of the pilot in Tianshui, in order to provide evidence for the province’s promotion.Methods The data of the Tuberculosis Management Information System, a subsystem of the China Information System for Disease Control and Prevention were used to analyze the indicators of case detection, treatment, management and drug-resistant tuberculosis prevention and control of tuberculosis in the pilot counties (districts). The indicators were compared before (2016) and after the pilot (2018). Five pilot counties (districts) reported 537 cases of tuberculosis in 2016 and 799 cases in 2018.Results At the end of the pilot in 2018, a hierarchical diagnosis and treatment system was established in Tianshui, and designated hospitals and diseases were identified at prefecture and county (district) level. At the end of 2018, the sputum examination rate of patients with suspicious symptoms of tuberculosis and suspected patients in the pilot counties was 97.29% (4460/4584), and the pathogenic positive rate of tuberculosis patients was 53.47% (347/649), the management rate of tuberculosis patients in primary health care institutions was 96.52% (748/775), the treatment success rate of tuberculosis patients was 94.53% (1623/1717), the drug screening rate of pathogenic positive patients was 80.35% (229/285), and the treatment rate of patients with drug-resistant tuberculosis was 81.25% (13/16). Compared to baseline indicators (which were 90.99% (7178/7889), 10.72% (185/1726), 89.80% (1550/1726), 90.03% (1554/1726), 52.31% (113/216) and 30.00% (3/10) respectively), the differences were statistically significant (χ ² values were 184.67, 495.85, 32.32, 24.35, 44.58, 4.84, P values were 0.000, 0.000, 0.000, 0.000, 0.000, 0.009). Conclusion The pilot counties (districts) in Tianshui have established a hierarchical diagnosis and treatment model for tuberculosis, improved the security policy of tuberculosis prevention and control, and significantly improved the prevention and control indicators, providing a preliminary scientific basis for the comprehensive promotion of pilot work experience.

Key words: Tuberculosis, Physician’s practice patterns;, Pilot projects, Evaluation studies, Small-area analysis