山东省依托乡村卫生组织一体化提高肺结核患者发现策略实施效果评价研究

发布时间：2018-03-05 22:18

本文选题：肺结核　切入点：乡村一体化　出处：《山东大学》2012年硕士论文　论文类型：学位论文

【摘要】：研究背景目前,我省多数县区正在开展或实施乡村卫生一体化改革,将村级卫生室的经营管理直接纳入乡镇卫生院管理。通过实行乡村一体化管理,合理规划和配置乡村卫生资源,规范服务行为,提高服务能力,促进新农合制度的巩固和完善,推动农村医疗卫生事业健康持续发展,满足广大农村居民的医疗卫生需求。我国是全球22个结核病高负担国家之一,每年新发肺结核患者131万,仅次于印度。结核病控制工作的核心内容是发现、治愈传染源。因症推荐肺结核可疑者是通过农村基层卫生组织发现肺结核病人的主要方式。乡村医疗卫生机构是省、市、县、乡、村五级防痨网的网底,在结核病防治中发挥着极其关键的作用,担负着肺结核可疑症状者的发现、推荐或转诊以及确诊结核病患者的管理工作。乡村卫生组织一体化管理为增加乡村医生推荐发现肺结核患者提供了机遇。研究目的通过分析干预措施对农村肺结核患者的发现方式、诊断延误和治疗延误的影响,评价依托乡村卫生组织一体化提高结核患者发现策略的效果。研究方法研究现场分为干预组县区和对照组县区,在干预组县区实施一定的干预措施。收集干预措施实施前后两组县区在结核病防治机构(以下简称：结防机构)登记的初治肺结核患者就医模式调查问卷,从县区结防机构常规报表、初诊结核病患者登记本等资料中获得部分数据。采用Epidata3.1建立数据库,并录入数据,使用SPSS17.0进行数据分析。在构成比的比较分析中采用卡方检验,在患者的就诊延误、治疗延误比较分析中采用秩和检验。主要结果 1、在干预前,干预组县区结防机构初诊肺结核可疑者来源以主动就诊方式为主,干预后,主动就诊方式所占比重有大幅度下降,由干预前的83.2%下降到干预后的51.1%；村医推荐就诊方式所占比重有了大幅上升,由干预前的2.0%上升到干预后的15.6%。干预组县区结防机构在干预前后初诊肺结核可疑者就诊结构的差异有统计学意义。 2、干预组县区干预前后结防机构初诊肺结核可疑者就诊症状分布不一致。咳嗽咳痰超过3周的可疑者所占的比例有所升高,由干预前的33.3%上升到干预后的41.4%；咳嗽咳痰少于3周的可疑者所占的比例有所下降,由干预前的45.7%下降到干预后的37.4%。干预组县区结防机构在干预前后初诊肺结核可疑者就诊症状分布的差异有统计学意义。 3、干预组县区结防机构初诊肺结核可疑者中诊断为肺结核的比例由干预前的19.5%增加到干预后的24.0%,排除结核的比例由干预前的80.4%下降到干预后的75.9%。干预组县区实施干预措施前后初诊肺结核可疑者诊断结果构成的差异有统计学意义。 4、实施干预措施后,干预组县区结防机构活动性肺结核患者发现数量较干预前增长6.1%,而同期对照组县区活动性肺结核患者发现数量较干预前减少8.9%。 5、实施干预措施后,干预组县区结防机构的确诊肺结核患者的就诊延误、诊断延误与治疗延误均比干预前有所缩短。结论与建议 1、干预措施使得初诊肺结核可疑者就诊结构发生重大改变,村医推荐可疑者所占比例较干预前明显升高,村医推荐在肺结核患者发现中的作用得到提升。 2、依托乡村卫生组织一体化采取的干预措施能够提高肺结核患者发现水平。 3、实施干预措施后,干预县初诊肺结核可疑者中确诊为肺结核的患者比例明显升高,排除结核的比例有所下降。这充分证明干预措施提高了肺结核患者发现的效率,使更多的肺结核患者得到了及时的规范治疗,也使得非结核患者免去了不必要的就医环节,节约了有限的卫生资源。 4、实施干预措施后,干预县肺结核患者发现工作的质量明显提高,肺结核患者的就诊延误、诊断延误、治疗延误较之干预前明显缩短。这说明基层一体化卫生组织发挥出较好的筛查效果,肺结核患者得到快速转诊和治疗,有效地控制了结核病的传播,同时也减轻了非结核患者的经济负担,避免了医疗资源的浪费。
[Abstract]:Research background
At present, most of the province's counties are carrying out or implementing the rural health integration reform, operation and management of the village health room directly into the township administration. Through the implementation of rural integrated management, rational planning and allocation of rural health resources, service behavior, improve service ability, consolidate and improve the new rural cooperative medical care system, promote the medical and health undertakings rural health and sustainable development, to meet the health demands of rural residents.
China is one of the 22 TB high burden countries, new year 1 million 310 thousand, pulmonary tuberculosis patients after India. The core content of TB control is found, the cure of infection. Because of illness recommended TB suspects through the rural health organization found that the main way of patients with pulmonary tuberculosis. The rural medical and health institutions is the province. City, county, township, the bottom five anti tuberculosis network of the village, plays a key role in TB prevention, charged with TB symptoms found, or recommended referral and management of tuberculosis patients. The integrated management of rural health organizations to increase rural doctors recommend found opportunities for pulmonary tuberculosis patients.
research objective
By analyzing the effect of intervention on the detection mode, diagnosis delay and treatment delay of rural tuberculosis patients, we evaluated the effect of relying on the integration of rural health organizations to improve the detection strategy of TB patients.
The study site is divided into intervention group and control group of counties and county, counties in the intervention group intervention. Intervention measures were implemented in two groups before and after the county in TB prevention and control institutions (hereinafter referred to as: TB) registered pulmonary tuberculosis patient model questionnaire, routine TB institutions report from the county, part of the data the data of newly diagnosed TB patients registered. Epidata3.1 was used to establish database, and input data, using SPSS17.0 for data analysis. The constituent ratio of the comparative analysis using chi square test, delay in treatment of patients with delayed treatment, comparative analysis by rank sum test.
Main results
In 1, before the intervention, the intervention group of county TB institutions in newly diagnosed pulmonary tuberculosis suspects in active treatment mode, intervention, active treatment mode proportion was greatly decreased from 83.2% before intervention after the intervention decreased to 51.1%; the village doctors recommend treatment way of the proportion has increased sharply, rising before the intervention to 2% after the intervention of 15.6%. intervention group counties TB control institutions, there was significant difference in the treatment of newly diagnosed pulmonary tuberculosis suspects structure before and after the intervention.
2, the intervention group before and after intervention in county TB institutions in newly diagnosed pulmonary tuberculosis suspects were inconsistent. Suspicious symptoms distribution of cough and expectoration for over 3 weeks, the proportion increased from 33.3% before intervention, after the intervention increased to 41.4%; less than 3 weeks of suspicious cough sputum accounted for by the decline cases. Decreased from 45.7% before intervention to intervention in the intervention group 37.4%. county TB control institutions, there was significant difference in the newly diagnosed pulmonary tuberculosis suspects symptoms distribution before and after the intervention.
3, the proportion of the intervention group counties TB institutions in newly diagnosed pulmonary tuberculosis suspects in the diagnosis of pulmonary tuberculosis from 19.5% before intervention to 24% after the intervention, the proportion of the exclusion of tuberculosis before intervention decreased to 80.4% after the intervention of 75.9%. intervention group counties before and after the implementation of interventions in newly diagnosed tuberculosis suspicious diagnosis results. The difference was statistically significant.
4, after the implementation of intervention measures, the number of active TB patients in the intervention group was increased by 6.1% compared with that before the intervention. Meanwhile, the number of active TB patients in the control group in the same period decreased by 8.9%. compared with those before the intervention.
5, after intervention, the intervention group of county TB diagnosed patients with pulmonary tuberculosis patient delay, diagnosis delay and treatment delay were shorter than before the intervention.
Conclusions and suggestions
1, intervention measures made significant changes in the structure of the suspected TB patients. The proportion of suspicious persons recommended by the village doctors increased significantly compared with those before the intervention. The role of the village doctors recommendation in the detection of TB patients increased.
2, intervention measures based on the integration of rural health organizations can improve the level of tuberculosis patients.
3, after intervention, intervention with newly diagnosed pulmonary tuberculosis suspects in county tuberculosis patients increased, excluding the decline in the proportion of tuberculosis. It is proved that the intervention measures to improve the efficiency of detection of tuberculosis patients, and has the more standardized treatment of patients with pulmonary tuberculosis, but also makes the non tuberculosis the patients from unnecessary medical links, save the limited health resources.
4, after intervention, intervention in patients with pulmonary tuberculosis in the county found that improved the quality of patients with pulmonary tuberculosis patient delay, diagnosis delay and treatment delay than before the intervention significantly reduced. This shows that the integration of grass-roots health organization play a better effect of screening of patients with pulmonary tuberculosis, rapid referral and treatment, effective control the spread of tuberculosis and non tuberculosis but also reduce the economic burden of the patients, to avoid the waste of medical resources.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R521

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