行政干预与健康教育对提高肺结核病例发现率的影响

目的 评价行政干预和健康教育活动对提高医疗卫生单位的结核病防治工作参与，以及提高肺结核病例转诊率和发现的效果。方法 在湖南省三个市辖38个县（区），采取一系列卫生行政干预措施，开展对卫生服务提供者的健康教育和培训，加强卫生行政部门和医疗卫生单位对结核病防治工作的参与，分析通过肺结核病例的转诊和追踪后肺结核病例发现的变化以及对全省肺结核病例发现效果的影响。结果 三市、38县卫生行政部门对辖区结核病防治工作的行政干预和参与率为100％，各县人民医院肺结核病例转诊工作参与率100％，其他县级医疗卫生单位和乡镇卫生院结核病例转诊工作参与单位数，由项目实施前的230个增加到780个；医疗机构肺结核病例转诊率为90．6％，总到位率为85．8％；新涂阳患者发现数为10596例，比项目实施前一年增加了113．8％；在新涂阳病例总数中，由医疗机构转诊发现病例数为4546例，占40．7％；项目期间新涂阳病例发现数占全省同期新涂阳病例发现数的42．6％。结论 加强卫生行政部门的干预和对卫生服务提供者的健康教育和培训，是促进医疗卫生机构的合作和参与，提高结核病例的转诊和到位，有效地提高肺结核病例发现的重要措施。

Effect evaluation of the tuberculosis case detection through administrative intervention and health education

Objective Through administrative intervention and health education,to improve the development to PPM-DOTS strategy,strengthen the collaboration among health care facilities and increase the case detection rate.Methods A serial of administrative intervention methods,health education and training for the health care providers in 38 counties in 3 prefectures in Hunan were conducted.The involvement of the health administration department and health care facilities in TB control was explored.The case referral level was analyzed,and the effect of referral and tracing on case detection was evaluated in Hunan Province.Results DOTS commitment and participating rate was 100% in health administrative department of the 3 prefectures and 38 counties.County general hospital participating rate was 100%.The number of other health care facilities and township hospitals participating referral increased from 230 to 780.Referral rate was 90.6% in general hospital.Total arrival rate was 85.8%.The number of new smear positive TB was 10596,increasing 113.8% compared with that of the previous year.Among them,4546(40.7%) cases was detected and referred by general hospital.The number of new smear positive TB detected by the study was 42.6% of the total in the province in same duration.Conclusion Strengthening the administrative intervention and health education is an important method to improve collaboration among health care facilities,increase referral and tracing of TB cases,and effectively increase case detection.