关键词: 结核, 肺, 结核, 抗多种药物性, 资本筹集, 费用, 医疗, 患者拒绝治疗

Abstract: Objective  To explore and describe the proportion and the reasons for multidrug-resistant tuberculosis patients nonparticipation of proper treatment. Methods  Five prefectures (Daqing of Heilongjiang, Quzhou of Zhejiang, Puyang of He’nan, Tianjin, Wanzhou of Chongqing) with different financing models were selected as settings by specialists panel of the key national science and technology program. Two hundred and thirty five MDR-TB patients confirmed by traditional DST between Mar 1^st, 2010 and Feb 29^th, 2012 were selected as study objects. All of them received face to face or telephone interview by the trained professionals with half-structured questionnaire including individual information (such as name, gender, age, occupation, income, notification classification, whether enrolled or not) and reasons of nonparticipation (financial risk, health, concerns, transportation, attitude and judgment of doctors, others).  Results  Proportion of patients not enrolled varied by financing models. The non-enrollment proportions were 39.0%（46/118）, 50.0%（25/50）and 71.6%（48/67）respectively（χ²=17.809，P<0.01） in all-free model, only free for drugs model, and all paid by patients model. The main reason of nonparticipation of all-free model is death（37.0%，17/46）, refusing enrollment（21.7%，10/46）, loss of contact（17.4%，8/46）; of only free for drugs model is loss of contact（64.0%，16/25）, transfer-out（16.0%，4/25）, refusing enrollment（12.0%，3/25）; of paid all by patients model is economic difficulties(33.3%，16/48), death(22.9%，11/48), loss of contact(16.7%，8/48)（χ²=62.326，P=0.000）. The reasons for non-enrollment are significantly different by models. The non-enrollment proportion could reduce 39.1%（18/46）, 64.0%（16/25） and 50.0%（24/48） respectively if we could solve refusing and loss of contact issue in all-free model, loss of contact in only free for drug model and economic difficulties and loss of contact for all paid by patients model.  Conclusion  Proportion of nonparticipation for proper treatment of MDR-TB cases will decline with the increase of the scope of free treatment. In addition to the economic difficulties, the study shows that nonparticipation may also relate to other reasons like loss of contact, death during waiting for DST results, refusing enrollment and severe complications.

Key words: Tuberculosis, pulmonary, Tuberculosis, multidrug-resistant, Capital financing, Fees, medical, Treatment refusal