关键词: 结核, 肺/药物疗法, 病人隔离, 医院管理, 北京市

Abstract: Objective  To explore the factors affecting the hospitalization treatment of smear positive pulmonary tuberculosis patients and provide reference for related policies of TB management in Beijing. Methods  A questionnaire was used to interview 340 smear positive pulmonary tuberculosis patients who registered in Chaoyang District Center for Disease Control and Prevention of Beijing from November, 2012 to August, 2014. The questionnaires was designed by experts, and its reliability Cronbach’s alpha coefficient was 0.85 and the reliability is good. The questionnaire includes 8 demographic characteristics（gender, age, residence, medical insurance, education level, marital status, family income source, family income） and 4 clinical signs and symptoms (whether with diabetes, whether cavitary PTB, the number of lung cavity and tuberculosis symptoms, including fever, cough, sputum, hemoptysis, chest pain, shortness of breath, fatigue, night sweats, body weight reduction). SAS 9.3 was used for univariate and multi-factor unconditional logistic regression analysis, P＜0.05 is considered statistically significant difference. Results  There were 328 TB patients who completed the final survey, among them, the response rate was 96.47% (328/340).76.83%（252/328）patients refused to be hospitalized for isolated treatment and 23.17% (76/328) received isolation treatment. Among patients who refused to live in hospital, the expense problem accounted for 52.38%（132/252）. The univariate analysis has shown the following factors statistically significant. They are the family residence (for patients received hospitalization treatment, the local family residence accounted for 65.79%（50/76）, the nonlocal family residence accounted for 34.21% (26/76); for patients refused the hospitalization, the local family residence accounted for 26.59%（67/252）, the nonlocal family residence accounted for 73.41%（185/252）; χ²=39.11，P<0.01); medical insurance (for patients received hospitalization treatment, the medical insurance accounted for 86.85%（66/76）, the new rural cooperative medical system：7.89% (6/76), at own pocket:5.26%（4/76）; for patients refused the hospitalization, the medical insurance accounted for 39.28%（99/252）, the new rural cooperative medical system：9.13%（23/252）, at own pocket: 51.59%（130/252）；χ²=57.02，P<0.01); family annual per-capita income (for patients received hospitalization treatment, 10 000:1.32%（1/76）, 20 000: 1.32%（1/76）, 30 000: 25.00%（19/76）, 40 000: 19.73%（15/76）, above 40 000: 52.63%（40/76）; for patients refused the hospitalization, 10 000: 31.35%（79/252）, 20 000: 8.73%（22/252）, 30 000: 13.10%（33/252）, 40 000: 17.06%（43/252）, above 40 000: 29.76%（75/252）；Z=5.28，P<0.01)；whether suffering from diabetes mellitus (for patients received hospitalization treatment, not with 76.32%（58/76）, yes 23.68%（18/76）；for patients refused the hospitalization, not with 88.49%（223/252）, yes 11.51%（29/252）；χ²=7.05，P<0.01); whether had cavitary PTB (for patients received hospitalization treatment, not with 67.11%（51/76）, yes 32.89%（25/76）；for patients refused the hospitalization, not with 78.17%（197/252）, yes 21.83%（55/252）；χ²=3.88，P<0.05); age (for patients received hospitalization treatment, average age 46.5（26，71）；for patients refused the hos-pitalization, average age 31.5（24，46）；Z=3.63，P<0.01); total score of all symptoms (for patients received hospitalization treatment 2（1，3）, for patients refused the hospitalization 2（1，2）；Z=2.37，P<0.05). The multiple variants logistic regression showed that age （Waldχ²=15.083，P<0.01，OR=1.045,95%CI=1.022-1.068）；marital status （Waldχ²=10.525，P=0.01，OR=5.484,95%CI=1.961-15.335）; family annual per-capita income（Waldχ²=22.087，P<0.01，OR=2.028,95%CI=1.510-2.723）；medical insurance（Waldχ²=21.444，P<0.01，OR=14.861,95%CI=4.742-46.571）; the new rural cooperative medical system（Waldχ²=6.645，P=0.01，OR=6.847,95%CI=1.586-29.562）; whether suffering from cavity（Waldχ²=3.877，P<0.05，OR=0.473,95%CI=0.225-0.997） and total score of all symptoms （Waldχ²=6.398，P<0.05，OR=1.447,95%CI=1.087-1926） are the influence factors for the isolation treatment of TB patients. Conclusion  The smear positive pulmonary tuberculosis patients with older age, higher family income, higher total score of all symptoms, suffering from PTB lung cavity, are more likely to be hospitalized for isolated treatment; compared with unmarried patients and self-paid patients, the patients who got married and covered by medical insurance/socialized medicine and the new rural cooperative medical system are more likely to be hospitalized for isolated treatment.

Key words: Tuberculosis, pulmonary/drug therapy, Patient isolation, Hospital administration, Beijing city