关键词: 结核, 公共卫生工作, 卫生服务管理, 评价研究

Abstract:

Objective The aim of this was to evaluate the policy and implementation effect of tuberculosis patients health management services for the basic public health projects in Shaanxi Province, and provide reference for further improving and implementing the tuberculosis prevention and control mode in primary medical institutions.Methods The implementation and assessment programs of tuberculosis patients health management service for the basic public health project in Shaanxi Province issued in 2017 and 2018 by the Health Commission of Shaanxi Province were collected, and then the five contents of work objectives, tasks, workflow, budget and performance appraisal were refined. Combined with special supervision and research as well as the data of “Quarterly Report on Tuberculosis Prevention and Control in Primary Medical Institutions” and “National Tuberculosis Patient Information Management System”, this paper evaluated the specific practices, organizational implementation and effect of the tuberculosis patients health management service for the basic public health projects in Shaanxi Province. In 2018, 43816 cases of suspected symptoms of pulmonary tuberculosis were recommended to county-level designated hospital by primary medical institutions, of which 4183 cases were diagnosed as active pulmonary tuberculosis, and 21401 cases with common pulmonary tuberculosis and 318 rifampicin-resistant tuberculosis patients were managed.Results The number of recommended newly diagnosed patients by primary medical institutions accounted for 37.05% (43816/118266) of the total number of first registered in provincial designated hospitals in 2018, and the number in each quarter (Q1: 22.08% (6565/29729), Q2: 36.13% (10892/30150), Q3: 39.81% (11028/27702), and Q4: 49.96% (15331/30685); {\chi }_{\mathrm{trend}}^2 =4921.82, P=0.000) showed an upward trend. Among the suspected symptoms of tuberculosis recommended by primary medical institutions, the confirmed active pulmonary tuberculosis patients accounted for 18.00% (4183/23237) of active pulmonary tuberculosis patients in the province, which was lower than other sources of confirmed patients (including referral, follow-up, and active visits) with the rate of 25.59% (19054/74450), and the difference was statistically significant (χ ²=4498.52, P=0.000). The notification rate, management rate, and contracted rate of common pulmonary tuberculosis were 93.81% (21798/23237), 98.18% (21401/21798), and 92.49% (20161/21798), respectively, which reached the goal of 90% of the national requirements. The notification rate of rifampicin-resistant tuberculosis patients was only 60.98% (325/533), while the management rate was 97.85% (318/325), reaching the goal of 90%; and the contracted rate was 88.62% (288/325) that slightly lower than the goal of 90%.Conclusion The tuberculosis patient health management service of the basic public health project in Shaanxi Province has strengthened the recommendation of suspected tuberculosis patients in primary medical institutions, and promoted the realization of the goal on the management rate and contract rate of tuberculosis patient, which can provide reference for other areas. However, the quality of recommendation for suspected tuberculosis patients and the contracting service for rifampicin-resistant tuberculosis patients need to be further improved.

Key words: Tuberculosis, Public health practice, Health services administration, Evaluation studies