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中国防痨杂志 ›› 2015, Vol. 37 ›› Issue (1): 30-34.doi: 10.3969/j.issn.1000-6621.2015.01.007

• 论著 • 上一篇    下一篇

全国结核病防治工作模式与患者发现和治疗管理水平分析

李涛 成诗明 杜昕   

  1. 102206 北京,中国疾病预防控制中心结核病预防控制中心
  • 收稿日期:2014-10-16 出版日期:2015-01-10 发布日期:2015-02-08
  • 通信作者: 杜昕 E-mail:stat@chinatb.org

Analysis of national tuberculosis control work mode with patients detection and treatment

LI Tao, CHENG Shi-ming, DU Xin   

  1. National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention,Beijing 102206,China
  • Received:2014-10-16 Online:2015-01-10 Published:2015-02-08
  • Contact: DU Xin E-mail:stat@chinatb.org

摘要: 目的 研究不同防治工作模式的县(区)患者发现和治疗管理情况,为进一步建立和完善新型结核病防治(简称“结防”)服务体系提供依据。 方法 由结核病管理信息系统导出2012年和2013年全国各县(区)患者登记和治疗管理数据。在2627个县(区)中,符合“结防机构模式”的单位为1523个,符合“定点医院模式”的单位为750个,符合“转型定点医院模式”的单位为283个,符合“转型结防机构模式”的单位为71个,并将各县(区)按照不同工作模式进行分类对比,分析不同模式下防治工作执行的效果和变化情况。 结果 截至2013年底,全国已经有39.3%(1033/2627)县(区)实行了“三位一体”的新型结核病防治工作模式(即结核病防治机构、定点医院、基层卫生服务机构“三位一体”的综合服务体系)。相比2012年,2013年“结防机构模式”、“定点医院模式”、“转型定点医院模式”、“转型结防机构模式”4种不同工作模式的县(区)中,新涂阳肺结核患者登记数分别下降了13.5%(24 032/178 033,2012年登记178 033例,2013年登记154 001例)、9.2%(8276/89 866,89 866、81 590)、22.3%(6698/30 044,30 044、23 346)和2.2%(164/7297,7297、7133),新涂阳肺结核占活动性肺结核患者的比例(简称“新涂阳比例”)分别下降了3.3%(2012年新涂阳比例37.4%,2013年34.1%)、2.0%(33.1%,31.1%)、5.9%(34.6%,28.7%)和-0.3%(34.1%,34.4%)。实施“结防机构模式”、“定点医院模式”、“转型定点医院模式”、“转型结防机构模式”的县(区)2012年上半年登记的新涂阳患者治愈率分别为94.0%(89 088/94 786)、93.1%(43 185/46 394)、94.1%(14 512/15 421)和93.9%(3702/3943);2013年上半年,治愈率分别为93.1%(72 180/77 521)、91.7%(36 622/39 950)、90.4%(10 565/11 683)和91.8%(3187/3470)。2013年“转型定点医院模式”的县(区)在2012年上半年登记的新涂阳患者治愈率为94.1%(14 512/15 421)与“结防机构模式”的县(区)治愈率(89 088/94 786,94.0%)间比较差异无统计学意义(χ2=0.321, P=0.571);而在2013年转型后,二者的治愈率分别为90.4%(10 565/11 683)和93.1%(72 180/77 521),差异有显著性统计学意义(χ2=108.550, P<0.0001)。 结论 全国已有较多的县(区)级结核病防治机构进行了工作模式转型,刚实施“转型定点医院模式”的县(区)患者发现(登记数)和治疗管理(治愈率)工作都受到一定影响,各部门需加强相关协调管理和督导考核工作。

关键词: 结核/预防和控制, 医师诊疗模式, 登记

Abstract: Objective Analyze patients detection and treatment in groups of counties with different TB control work mode, in order to enhance new TB control system.  Methods Collect the data of patients detection and treatment in 2012 and 2013 in county level from TB Management Information System, then divide the counties into different groups by work mode, and analyze their performance and trends. In the total 2627 counties, 1523 counties are defined as “tuberculosis (TB) control center mode”, 750 as “public-public mix (PPM) Mode”, 283 as “PPM transition mode”, and 71 as “TB control center transition mode”.  Results There are 39.3% (1033/2627) of counties in China have already changed their work mode to the new PPM TB control work mode (Collaboration of TB control center, designated hospitals and primary public health institutions) till end of 2013. Compared to 2012, in the four different type of counties with different work mode (“tuberculosis (TB) control center mode”, “PPM mode”, “PPM transition mode”, “TB control center transition mode”), the number of new smear positive patients (S+) registered have declined 13.5%(24 032/178 033, 178 033 patients registered in 2012,154 001 registered in 2013, similarly hereinafter), 9.2%(89 866,81 590,8276/89 866), 22.3%(30 044,23 346, 6698/30 044) and 2.2%(7297, 7133, 164/7297), the proportion of S+ accounted for patients with active pulmonary tuberculosis have declined 3.3%(37.4% in 2012, 34.1% in 2013, similarly hereinafter), 2.0%(33.1%, 31.1%), 5.9%(34.6%, 28.7%) and -0.3%(34.1%, 34.4%). The cure rate of new S+ registered in the first half year of 2012 in 4 types of counties above-mentioned are 94.0%(89 088/94 786), 93.1%(43 185/46 394), 94.1%(14 512/15 421) and 93.7%(3702/3943). The corresponding rate for S+ registered in the first half year of 2013 are 93.1%(72 180/77 521), 91.7%(36 622/39 950), 90.4%(10 565/11 683) and 91.8%(3187/3470). The cure rate of 2012 in “PPM transition mode” counties (94.1%, 14 512/15 421) have no difference with “TB control center mode” counties (94.0%, 89 088/94 786, χ2=0.321, P=0.571), but, when these counties changed their work mode in 2013, the cure rate have changed into 90.4%(10 565/11 683) and 93.1%(72 180/77 521), the significant differences appeared(χ2=108.550, P<0.0001).  Conclusion There have already much counties changed their work mode to PPM mode. The TB control work, such as the number of patients detection and the cure rate, in “PPM transition mode” counties may be weakened in the transition period, the relative departments must enhance their management and supervision work.

Key words: Tuberculosis/prevention &, control, Physician&, rsquo, s practice patterns, Registries