典型医疗机构尘肺病低报情况研究

发布时间：2018-01-17 23:06

本文关键词：典型医疗机构尘肺病低报情况研究　出处：《中国疾病预防控制中心》2017年硕士论文　论文类型：学位论文

【摘要】：职业病低报研究属于公共卫生监测系统评价的重要内容之一,它体现监测系统发现和确认职业病危害问题的能力。开展尘肺病低报研究,从医疗可及性、漏诊、漏报等角度,估计低报程度,了解低报原因并提出改进措施,对于改进和完善职业病监测系统、提高监测效率、确保监测系统发现职业病数量的准确性、更好的了解分布特征和变化趋势、发现爆发和流行等情况具有重要意义。[目的]调查尘肺病低报程度,了解造成低报的各种可能因素和关键环节,提出改进措施。[方法]本研究采取文献研究法进行研究设计,应用临床职业病学方法回顾性分析4家典型医疗机构(分别为:具有诊断资质的职业病防治院1家、具有诊断资质的综合医院1家、不具有诊断资质的综合医院1家、不具有诊断资质的胸科医院1家)2016年临床病例信息来估计疑似尘肺病、尘肺病的低报程度,采用问卷调查和访谈法探索低报的原因,并提出改进建议。[结果]研究结果显示4家医疗机构阳性病例821例,其中70人已经诊断职业性尘肺病,其他未做职业病或疑似职业病的诊断,总漏诊率91.47%,具有非诊断资质的两家医院疑似尘肺病漏诊率为100%。已经诊断的70例职业性尘肺病人均已上报,报告信息与病例资料核对完整无误,漏报率为0。问卷调查结果显示综合医院相关科室非尘肺病诊断医师的职业病知识知晓率为31.1%,接受培训的知晓率高于未接受过培训的医师。呼吸科(100%)、感染科(100%)接诊尘肺病人比例较高,50%以上的医师不具有鉴别诊断职业病的能力,医师普遍对本单位是否有职业病报告系统不太了解或理解错误,69.7%调查对象认为非职业病诊断机构有必要报告职业病。所有尘肺病诊断医师都遇到过怀疑是尘肺病但无法诊断的情况,无法诊断的原因主要是:影像学表现不到诊断标准(73.9%)、无法获取职业史资料(69.6%)和病人主动选择中止诊断(60.99%),尘肺病诊断医师同样存在不能鉴别诊断尘肺病现象,没有报告疑似职业病的原因是认为没有疑似职业病的诊断标准。调查结果还显示96.2%的确诊职业性尘肺病人受教育水平在初中以下,从事矿山行业的占85.7%,对职业病诊断所需资料的知晓情况较差,68.5%的患者信息来源于亲眼看到别人的经历。32.1%的患者在非职业病诊断机构就诊过,也存在医生忽视尘肺症状、对诊断制度不了解的情况。访谈结果显示流动工人的职业病诊断存在困难、非职业病诊断医疗机构存在漏诊和误诊现象、用人单位抵触、工人主动放弃职业性尘肺病诊断、疑似职业病低报是尘肺病低报的主要原因。[结论]调查显示目前疑似尘肺病低报程度较高,主要存在于职业性尘肺病就诊环节,确诊的尘肺病在报告环节低报程度较低,非职业病诊断机构的低报程度高于职业病诊断机构。低报主要受诊断标准设置、医师诊断能力、病人无法获取职业史资料和病人主动选择中止诊断等因素影响。建议进一步加强职业病知识宣传培训、加强职业健康监护工作、职业病临床诊断与职业病认定程序分步实施、提高职业病诊断标准灵敏度、明确疑似职业病的定义和诊断标准、加强尘肺病鉴别诊断领域和特异性生物标志物研究、应用多种数据来源进行职业病监测。
[Abstract]:One of the important content of low report on occupation disease belongs to public health surveillance system evaluation, it embodies the monitoring system to find and confirm the ability of occupation disease harm problem. To carry out the research on low reported pneumoconiosis, from the medical accessibility, misdiagnosis, negative angle estimation reported lower degree, understand low reported reasons and propose the improvement measures. For improving and perfecting the occupation disease monitoring system, improve monitoring efficiency, ensure the accuracy of the monitoring system that the number of occupation disease, a better understanding of the distribution characteristics and change trend, found that the outbreak and epidemic situation has important significance. In order to investigate the pneumoconiosis reported lower degree of understanding, cause a variety of understating the possible factors and key links put forward the improvement measures. Method: this research adopts literature research method to research design, clinical application of occupation disease methods: a retrospective analysis of 4 typical medical institutions (respectively: a diagnostic qualification Occupation Disease Prevention Hospital 1, general hospital has diagnostic qualified 1, does not have a comprehensive hospital diagnosis qualification 1, does not have the qualification of the diagnosis of Chest Hospital 1 2016) clinical information to estimate the suspected pneumoconiosis, reported lower degree of pneumoconiosis, and explore the reasons for underreporting by questionnaire and interview method, and put forward the improvement proposal. The results showed that 4 medical institutions were 821 cases, 70 of whom have occupation of diagnosis of pneumoconiosis, the other without occupation disease or suspected occupation disease diagnosis, the total misdiagnosis rate 91.47%, with a diagnosis of non qualification of the two hospital suspected pneumoconiosis misdiagnosis 70 cases occupation of the pneumoconiosis patients have been diagnosed as 100%. have been reported, the report information and case data check is complete and accurate, the miss rate of 0. survey results show that the occupation disease knowledge related department of General Hospital of non physician diagnosis of pneumoconiosis awareness rate was 31 .1%, know the training rate is higher than that of untrained doctors. The Department of respiration (100%), infectious diseases (100%) admissions of pneumoconiosis patients in high proportion, more than 50% of the physicians do not have the ability of differential diagnosis of occupation disease, doctors generally on the unit whether the occupation disease reporting system don't know or understand the mistake, the 69.7% survey the object of diagnosis that non occupation disease is necessary to report occupation disease. All pneumoconiosis diagnosis physicians have encountered suspected pneumoconiosis but not diagnosis, reason cannot diagnose is mainly: imaging to diagnosis standard (73.9%), unable to obtain the occupation history (69.6%) and the patients actively choose to abort diagnosis (60.99%), physician diagnosis of pneumoconiosis is also unable to be differential diagnosis of pneumoconiosis, no reason to report suspected occupation disease is that there is no diagnostic criteria for suspected occupation disease. The survey also showed that 96.2% indeed Diagnosis of pneumoconiosis occupation education in junior high school, engaged in the mining industry accounted for 85.7% of the required information for the diagnosis of occupation disease awareness is poor, 68.5% of the patients with information from the experience of others to see.32.1% patients in diagnosis of non occupation disease, there are also doctors do not understand the neglect of pneumoconiosis symptoms. The diagnosis system. The result of the interview shows occupation disease diagnosis problems of migrant workers, non occupation disease diagnosis medical institutions exist misdiagnosis phenomenon, conflict with the employer, workers take the initiative to give up the occupation of pneumoconiosis diagnosis, suspected occupation disease is a major cause of low reported pneumoconiosis reported lower. Conclusion] investigation shows that at present the suspected pneumoconiosis reported lower level high, mainly exists in the occupation of the pneumoconiosis medical aspect diagnosed pneumoconiosis in reporting aspects of low reported low level, low degree of organization occupation disease diagnosis report high In the diagnosis of disease. The main occupation mechanism of low reported by diagnostic standard setting, physician diagnosis ability, patients cannot obtain the occupation history data and patient diagnosis active choice and other factors. It is recommended to further strengthen the occupation disease knowledge training, strengthen the occupation health supervision work, occupation disease diagnosis and occupation disease identification procedure step by step, improve the standard of sensitivity the diagnosis of suspected occupation disease, clear definition and diagnostic criteria of occupation disease, strengthen the pneumoconiosis differential diagnosis and field studies on specific biomarkers of occupation disease monitoring application of multiple data sources.

【学位授予单位】：中国疾病预防控制中心
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R135.2

【参考文献】