宁夏海原县结核病控制现状及患者发现过程中的延迟影响因素分析

发布时间：2018-05-03 18:53

本文选题：结核病 + 控制现状　；参考：《宁夏医科大学》2017年硕士论文

【摘要】：目的通过对宁夏海原县结核病患者的就医行为调查,了解海原县结核病患者的基本情况和结核病控制现状及结核病患者发现过程中的延迟情况并分析其延迟的影响因素,为宁夏的结核病防控工作提供科学的理论依据和建议。方法对海原县2012年7月1日至2013年6月30日经过确诊和已完成规范治疗的所有结核病患者进行面对面的现场调查,结合海原县结核病患者初诊登记本和海原县结核病疑似病人转诊单得到结核病患者基线资料。运用均数、标准差、中位数、四分位数间距对定量资料进行统计学描述分析,对定性资料采用构成比进行统计学描述分析。分别用卡方检验和非条件Logistic回归对结核病患者延迟原因进行单因素分析和多因素分析(a=0.05)。结果1.本次共调查海原县结核病患者217人,男性107人,女性110人,平均年龄56.5±19.2岁,汉回比例为1:4.7,文化程度以文盲为主,职业以农民为主。2.31.8%的患者在出现结核症状后未立即就医;仅有34.1%的患者有能力在结核病治疗期间承担自付部分医疗费用;在患结核病期间高达62.2%的患者因结核病的治疗而负债;在治疗期间,仅有56.2%的结核病患者不用其他人监督而自行服药,69.6%的结核病患者表示有医务人员到家随访;41.5%的患者表示在治疗结束时,医生未告知其结核病是否已经治疗好;仅有13.8%的患者患结核病前了解结核病知;患者对医院就诊流程方便性满意度为78.8%,对医生所介绍的肺结核相关知识的满意度为77.0%,对医院结核科就诊环境满意度为86.2%,对医保补助政策满意度为60.8%。3.患者就诊延迟率为57.1%,延迟中位数为51.5天,四分位数间距为94.0天;患者转诊延迟率为23.6%,延迟中位数为23.0天,四分位数间距为40.0天;患者确诊延迟率为38.7%,延迟中位数为45.0天,四分位数间距为69.2天;患者发现延迟率为53.9%,延迟中位数为79.0天,四分位数间距为13.0天。4.文化程度、职业和出现结核症状后采取措施不同的患者就诊延迟差异有统计学意义(P0.05);文化程度和出现结核症状后采取措施是患者就诊延迟的影响因素(P0.05)。住所离乡镇卫生院的距离、结核病患者首诊医疗机构不同的患者转诊延迟差异有统计学意义(P0.05);住所离乡镇卫生院的距离和首诊医疗机构是患者转诊延迟的影响因素(P0.05)。年龄、文化程度、住所离县结防机构的距离、住所离乡镇卫生院的距离、首诊医疗机构不同的患者确诊延迟差异有统计学意义(P0.05);治疗结核病全程花费、住所离县结防机构的距离、住所离乡镇卫生院的距离、首诊医疗机构是结核病患者确诊延迟的影响因素(P0.05)。首诊医疗机构不同的患者发现延迟差异有统计学意义(P0.05);首诊医疗机构是患者发现延迟的影响因素(P0.05)。结论1.结核病患者文化程度偏低,健康意识不强,接受结核病知识的方式较为被动,结核病知识知晓率低;患者收入偏低,对医保补助政策满意度较低,疾病负担依然很重。很多结核病患者仍然是被动服药,患者服药依从性不高。2.结核病患者发现过程中的延迟情况不容乐观。3.不同职业的患者间就诊延迟发生存在差异;文化程度低、出现结核症状后未立即到医疗机构就诊的患者更易发生就诊延迟。4.住所距乡镇卫生院的距离远和首诊是县级以下医院的患者越易发生转诊延迟。5.不同年龄和文化程度的患者间确诊延迟发生存在差异;结核病全程治疗花费少、住所距乡镇卫生院的距离远、距县结防机构远和首诊是县级以下医院的患者越容易发生确诊延迟。6.首诊是县级以下医院的患者更容易发生发现延迟。
[Abstract]:Objective to investigate the medical behavior of patients with tuberculosis in Haiyuan County, Ningxia, to understand the basic situation of tuberculosis patients in Haiyuan County, the status of tuberculosis control and the delay in the detection of TB patients and to analyze the influencing factors of the delay, and provide scientific theoretical basis and suggestions for the prevention and control of tuberculosis in Ningxia. From July 1, 2012 to June 30, 2013 in Haiyuan County, all cases of tuberculosis patients who had been diagnosed and finished with standardized treatment were investigated in face to face, and the baseline data of TB patients were obtained from the first diagnosis registration of the patients with tuberculosis in Haiyuan county and the referral form of suspected TB patients in Haiyuan county. The average number, standard deviation, median, four division were used. The quantitative data were analyzed statistically and the qualitative data were analyzed with statistical description. Single factor analysis and multiple factor analysis (a=0.05) were used to analyze the delayed causes of tuberculosis patients with chi square test and unconditional Logistic regression. Results 1. cases were investigated in 217 cases of tuberculosis patients in Haiyuan county and 107 men. The average age of 110 people was 56.5 + 19.2 years old, the average age was 56.5 + 19.2 years, the proportion of Han Hui was 1:4.7, the education level was mainly illiterate. The patients who were mainly.2.31.8% were not immediately hospitalized after the symptoms of tuberculosis; only 34.1% of the patients had the ability to pay part of the medical expenses during the period of TB treatment, and 62.2% of the patients during the period of tuberculosis were due to the disease. In the course of treatment, only 56.2% of TB patients took their own medicine without the supervision of other people, and 69.6% of the patients were followed up by medical staff, and 41.5% of the patients said that at the end of the treatment, the doctor did not tell whether the TB had been cured; only 13.8% of the patients had a pre tuberculosis understanding. The patient's satisfaction with the hospital consultation process was 78.8%, the satisfaction of tuberculosis related knowledge introduced by the doctors was 77%, the degree of satisfaction to the hospital tuberculosis department was 86.2%. The delay rate of 60.8%.3. patients was 57.1%, the median delayed median was 51.5 days, and the four quantile interval was 94. The delayed rate was 23.6%, the delayed median was 23 days, the four digit spacing was 40 days, the patient's delay rate was 38.7%, the delayed median was 45 days, the four digit spacing was 69.2 days, the delayed rate was 53.9%, the delayed median was 79 days, the four digit interval was 13 days.4. culture, occupation and tuberculosis. There was statistical significance (P0.05) for patients with different measures after taking different measures, and the influence factor (P0.05) on the delay of patient visits after the onset of tuberculosis symptoms (P0.05). The distance between the residence and the township hospital was significant (P0.05). The distance from the township hospital and the first visit medical institution were the factors affecting the patient's delay of referral (P0.05). Age, the education level, the distance from the shelter from the county and the distance from the township hospital, the difference of the delay in the diagnosis of different patients in the first medical institutions (P0.05); the whole course of treatment of tuberculosis and residence. The distance between the county and the village, the distance between the residence and the township hospital, the first medical institution was the influence factor of the delay of diagnosis of tuberculosis patients (P0.05). The difference of the delay was statistically significant (P0.05). The first medical institution was the influence factor of the patient's discovery delay (P0.05). Conclusion 1. tuberculosis patient culture Low level, poor health awareness, passive tuberculosis knowledge, low awareness of tuberculosis knowledge, low income of patients, low satisfaction with medical insurance subsidy policy, and still heavy burden of disease. Many patients with tuberculosis are still passively taking medicine and the patient's compliance is not high in.2. tuberculosis patients. It is not optimistic that there is a difference in the delay between patients with different professions. The low education level, the patients who have not immediately come to the medical institution after the symptoms of tuberculosis are more likely to have a delay in visiting the hospital and the distance of the.4. residence is far away from the township health center and the first diagnosis is that the more susceptible the patients at the county level hospital are to delay.5. and the different ages and cultures of.5.. There is a difference in the degree of delayed diagnosis between patients; the cost of the whole course of tuberculosis treatment is less, the distance from the residence distance from the township hospital is far. The patient with the county hospital in the county below and the first diagnosis is the easier to delay the diagnosis of the first diagnosis of the.6..

【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R52

【参考文献】