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中国防痨杂志 ›› 2018, Vol. 40 ›› Issue (6): 578-582.doi: 10.3969/j.issn.1000-6621.2018.06.006

• 论著 • 上一篇    下一篇

黑龙江省耐多药肺结核患者登记治疗的管理现状分析

杨忠喜,于艳玲(),闫兴录,王晓楠   

  1. 150030 哈尔滨,黑龙江省结核病预防控制中心
  • 收稿日期:2018-03-14 出版日期:2018-06-20 发布日期:2018-07-24

Investigation and analysis on the status of registration and management of multidrug-resistant pulmonary tuberculosis in Heilongjiang province

Zhong-xi YANG,Yan-ling YU(),Xing-lu YAN,Xiao-nan. WANG   

  1. Heilongjiang Province Center for Tuberculosis Control and Prevention, Harbin 150030, China
  • Received:2018-03-14 Online:2018-06-20 Published:2018-07-24

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摘要： 目的

分析黑龙江省耐多药肺结核登记、治疗管理现况,为黑龙江省下一步耐多药肺结核控制工作的开展提供借鉴。

方法

从中国疾病预防控制中心《结核病信息管理系统》和全省规模较大的7家结核病专科医院中收集2014年7月1日至2015年6月30日登记的耐多药肺结核患者796例,其中结核病防治机构(简称“结防机构”)登记患者150例,结核病专科医院登记患者646例;从中筛选出地址详细的患者393例,其中结防机构150例,结核病专科医院243例,采用统一的调查问卷(内容包括患者基本情况、就诊情况、登记录入情况、治疗情况和经济负担情况等),对同意接受调查的278例耐多药肺结核患者进行入户调查,对耐多药肺结核患者的登记录入、治疗及治疗现状等资料进行分析。

 结果

本次调查的患者中,结防机构发现的耐多药肺结核患者100.0%(150/150)登记并录入《结核病信息管理系统》,而结核病专科医院发现的患者仅2.2%(14/646)登记录入《结核病信息管理系统》,差异有统计学意义(χ 2=712.27,P<0.01)。结防机构发现的患者接受治疗率为54.8%(63/115),结核病专科医院发现的患者接受治疗率为92.6%(151/163),差异有统计学意义(χ 2=54.34,P<0.01)。结防机构发现的患者和结核病专科医院发现的患者坚持治疗率分别为69.8%(44/63)和78.1%(118/151),差异无统计学意义(χ 2=1.66,P=0.198);导致患者未坚持治疗的主要因素是经济因素,结防机构和结核病专科医院的患者中分别占63.5%(33/52)和75.1%(9/12),其次为取药不方便,分别占26.9%(14/52)和8.3%(1/12)。

结论

结核病专科医院患者登记和信息录入比率较低,需要建立无缝衔接的医防合作机制;患者中断治疗的主要原因是经济因素,应当争取当地医疗保险政策的支持,提高报销比率,减轻患者就医负担。

关键词: 结核, 肺, 结核, 抗多种药物性, 登记, 管理信息系统, 药物治疗依从性, 数据说明, 统计

Abstract: Objective

To analyze the current status of the registration and treatment management of multidrug-resistant pulmonary tuberculosis (MDR-PTB) in Heilongjiang province, and to provide reference for the following MDR-PTB control in Heilongjiang province.

Methods

Seven hundred and ninety-six MDR-PTB cases were collected from the Tuberculosis Information Management System (TIMS) of Chinese Center for Disease Control and Prevention (CCDCP) and the province’s 7 large tuberculosis specialized hospitals between July 1, 2014 and June 30, 2015. Among them, there were 150 cases from CCDCP and 646 cases from specialized hospitals. A total of 393 patients with detailed address were screened out, including 150 cases from CCDCP and 243 cases from specialized hospitals. The household survey using a standardized questionnaire was conducted on 278 MDR-PTB cases who consented to the survey. The items of the questionnaire included the basic information, situation of visits, registration and entry, treatment and financial burden. Data of registration, treatment and current status of treatment of the MDR-PTB patients were analyzed.

 Results

Among the patients surveyed, 100.0% (150/150) of the MDR-PTB patients from CCDCP were registered and entered in the TIMS, while only 2.2% (14/646) of the MDR-PTB patients from specialized hospitals were registered and entered in the TIMS; the difference was statistically significant (χ 2=712.27, P<0.01). The treatment rate of the patients identified by CCDCP was 54.8% (63/115), and the treatment rate of the patients identified by the specialized hospitals was 92.6% (151/163); the difference between was statistically significant (χ 2=54.34, P<0.01). The adherence rate to treatment was 69.8% (44/63) and 78.1% (118/151) for patients identified by the CCDCP and specialized hospitals, respectively, with no statistical significance (χ 2=1.66,P=0.198). The main factor affecting patients’ adherence to treatment was economic burden (63.5% (33/52) and 75.1% (9/12) of the patients from the CCDCP and specialized hospitals), followed by inconvenient access to medicine (26.9% (14/52) and 8.3% (1/12) of the patients from the CCDCP and specialized hospitals).

Conclusion

The rate of patient registration and information entry in tuberculosis hospital is low. Thus, we need to establish a seamless medical defense and cooperation mechanism. The main reason for treatment interruption is economic burden. It is necessary to strive for the support of the local medical insurance policy, improve the reimbursement rate and reduce the burden of patients.

Key words: Tuberculosis, pulmonary, Tuberculosis, multidrug-resistant, Registries, Management information systems, Medication adherence, Data interpretation, statistical

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