关键词: 结核,肺, 病例管理, 多机构系统, 卫生服务管理, 数据说明, 统计

Abstract: Objective To analyze the current situation of the treatment and management of pulmonary tuberculosis (PTB) patients in counties, townships and villages in 31 provinces (municipalities, autonomous regions) and Xinjiang production and construction corps, and to provide scientific basis for further improving the treatment and management efficiency and quality of PTB patients. Methods National Center for Tuberculosis Control and Prevention of Chinese Center for Disease Control and Prevention designed the questionnaire and conducted the investigation on the PTB patients treatment management of TB designated institutions and center for disease control and prevention (CDC) at county level and primary medical and health institutions among 2799 counties(districts) in 2018. The content of the questionnaire included the implementation of TB patient treatment and management, follow-up management, patients’ re-examination and refilling medicine, and management of treatment interrupted patients. The data were used to understand the task cohesion of patients’ treatment management in county (district), township and village. Results Among 2799 counties (districts) which were investigated, 2072 designated TB institutions were set up in hospitals (74.0%, 2072/2799), the numbers of TB designated medical institutions set up in TB dispensary, in CDC and in hospital for chronic diseases were 287 (10.3%, 287/2799), 296 (10.6%, 296/2799) and 74 (2.6%, 74/2799) respectively, 131 (4.7%, 131/2799) counties (districts) designated TB institutions didn’t transmit patients’ information to patients’ management institutions, and the proportion of non-transmission in hospitals was 5.6% (117/2072), and 1.1% (7/657) in TB dispensary, CDC and hospitals for chronic diseases. The difference was significant between the two types (χ²=24.138, P<0.01). 1016 (36.3%, 1016/2799) designated TB institutions transmitted patient information to CDC, 912 (32.6%, 912/2799) transmitted patient information to primary medical and health institutions, and 740 (26.4%, 740/2799) transmitted patient information to the above two institutions at the same time. The numbers of designated medical institutions transmitting patient information through paper, electronic, National Tuberculosis Information Management System (TBIMS) and other systems were 622 (22.2%, 622/2799), 1121 (40.1%, 1121/2799), 819 (29.3%, 819/2799) and 97 (3.5%, 97/2799), respectively, 127 (4.5%, 127/2799) CDC did not transmit patient information to primary medical and health institutions. 2430 (86.8%, 2430/2799) transmitted to township health agencies, 17 (0.6%, 17/2799) transmitted to village doctors, and 225 (8.0%, 225/2799) transmitted to both levels. The numbers of CDC transmitting patient information through paper, electronic, TBIMS and other systems were 694 (24.8%, 694/2799), 1611 (57.6%, 1611/2799), 178 (6.4%, 178/2799) and 183 (6.5%, 183/2799), respectively. The primary medical and health institutions of 1153 (41.2%, 1153/2799) counties (districts) did not send follow-up records, and the numbers of counties (districts) that sent follow-up records through paper, electronic version, TBIMS and other systems were 895 (32.0%, 895/2799), 289 (10.3%, 289/2799), 41 (1.5%, 41/2799) and 263 (9.4%, 263/2799), respectively, 158 (5.6%, 158/2799) counties (districts) sent follow-up records by other methods. If the patients were found with adverse reactions or other complications, grassroots doctors of 374 (13.4%, 374/2799) counties (districts) informed the doctor at county (district) level directly, those of 711 (25.4%, 711/2799) counties (districts) directly referred the patient to the county (district) institution, those of 1665 (59.5%, 1665/2799) counties (districts) dealt with minor adverse reactions, and those of 43 (1.5%, 43/2799) counties (districts) informed patients to the county (district) institution. The patients of 91.4% (2557/2799) county (district) took re-examination at county (district) institutions at the end of each month of treatment or at the end of the second, fifth and sixth month of treatment. The primary doctors of 1.2% (33/2799) county (district) did not remind the patients to take re-examination, and 37.8% (1058/2799) designated medical institutions at county (district) level did not remind the patients. The patients of 91.6% (2563/2799) county (district) received drugs from county (district) designated medical institutions, and the township health institutions of 84.9% (2376/2799) county (district) did not provide TB re-examination services. In 2240 (80.0%, 2240/2799) counties (districts), patients with interrupted treatment were found by primary doctors, and the primary doctors of 1382 (49.4%, 1382/2799) counties (districts) organized tracing of patients with interrupted treatment. Conclusion County (district) designated medical institutions, CDC and primary medical and health institutions have a good connection of their duties in the treatment and management of TB patients. All levels should do a good job in patient treatment management according to the requirements, and comprehensively improve TB patients’ treatment management.

Key words: Tuberculosis,pulmonary, Case management, Multi-institutional systems, Health services administration, Data interpretation, statistical