摘要
目的探讨并评价患者各类延误需采取的指标、数据收集方法及其可行性,为制定减少延误发生的干预措施提供科学依据。方法根据患者就医过程中的关键节点（出现症状、首次就诊、确诊结核病和开始治疗）定义了与延误相关的不同指标,包括总延误、就诊延误、诊断延误和治疗延误等;采取典型调查的方法,分别在东、中、西部各选择1个县（共3个县）作为研究现场,使用编制的《新发涂阳肺结核患者诊疗过程调查表》对研究现场的结核病防治（简称＂结防＂）机构2010年5—9月登记发现的初治涂阳肺结核患者进行面对面的问卷调查,共纳入患者329例。结果患者中男性占81.5%（268/329）,平均年龄51.8岁（95%CI：49.9~53.8）,农民占71.1%（234/329）,初中及以下文化程度者占86.6%（285/329）,年均纯收入低于5000元者占81.2%（267/329）;患者的总延误时间为36 d（0~597 d）,就诊延误15 d（0~594 d）,诊断延误10 d（0~429 d）,就诊延误与诊断延误的差异无统计学意义（t=1.596,P=0.111）;按照发生原因,结防机构因素导致的诊断延误为7 d（0~428 d）,患者因素导致的诊断延误为1 d（0~45 d）,两者间的差异有统计学意义（t=8.609,P=0.000）;按照就医关键节点,结核病可疑者的发现延误为0 d（0~428 d）,结核病可疑者的转诊延误为4 d（0~267 d）,两者间的差异有统计学意义（t=3.235,P=0.001）。结论使用该研究制定的延误指标可以更为深入地分析延误产生的原因。
Objective To validate the indicators used in evaluation of delay of TB patients before initiation of standard TB treatment and related data collection methods and their feasibility in order to provide evidence base for the development of relevant TB control and prevention strategies. Methods Indicators including total delay,health seeking delay,diagnostic delay,treatment delay were defined according to the critical nodes（onset of symptoms,first visit to doctor,TB diagnosis and treatment initiation） during the health seeking process.The typical survey methods were adopted and three counties were selected from the eastern,middle and western provinces each.New smear positive TB patients registered during May 2010 to September 2010 were administered face-to-face self-designed questionnaire survey.A total of 329 smear positive TB patients were enrolled in this study. Results In this study,male accounted for 81.5%（268/329）,the average age was 51.8（95% CI：49.9-53.8） years old,farmers accounted for 71.1%（234/329）,junior high school education or less were 86.6%（285/329）,an annual income of less than 5000 yuan accounted for 81.2%（267/329）;The total delay was 36d（0-597d）,health seeking delay was 15d（0-594d） and diagnostic delay was 10d（0-429d）,between the two there is no significant difference（t=1.596,P=0.111）;According to causes of delay,health system induced diagnostic delay was 7d（0-428d）,patient induced diagnostic delay was 1d（0-45d）,the difference between the two is statistically significant（t=8.609,P=0.000）;According to the key nodes in health seeking process,delay in detection of TB suspects was 0d（0-428d）,in referral of TB suspects was 4d（0-267d）,the difference between the two is statistically significant（t=3.235,P=0.001）. Conclusion The indicators designed in this study could give a more in-depth understanding of the causes of the delay.
出处
《中国防痨杂志》
CAS
2011年第10期633-636,共4页
Chinese Journal of Antituberculosis
基金
中国全球基金结核病项目实施性研究(08-009)
关键词
结核
肺/诊断
延误
问卷调查
Tuberculosis
pulmonary/diagnosis
Delay
Questionnairs
