医疗单位肺结核病归口管理方法的探讨

目的探索结核病人归口管理途径与方法,提高结核病人发现率,规范病人治疗管理。方法结合湖南省实际,制订切实可行的结核病人归口管理实施办法与措施;对全省2003年未实施结核病人归口管理与2004年实施结核病人归口管理的结果进行对照分析。结果全省2003年初诊病人为108 734例,2004年为159 534例,2004年比2003年增加50 800例,增长46.7%。其中全省2003年因症就诊、医疗单位转诊、和其他方式(集中推荐和因正推荐等)分别为80 150例、10 988例和17 596例,2004年分别为108 515例、27 116例和23 903例,2004年比2003年分别增长了35.4%、146.8%和35.8%。2001~2003年各年登记的涂阳病人数为20 000例左右,新涂阳病人登记率在23.6/10万~24.6/10万之间;2004年发现涂阳病人35 455例,比2003年增加了15 052例,增长率高达73.8%。新涂阳病人登记率增长至44/10万。其中,因症就诊、转诊和其他分别为20 403例1、0 794例和4 424例,分别比2003年增加6 552例、6 883例和1 617例,分别增长了47.9%、176.0%和239.7%;分别占43.5%、45.7%和10.7%。2004年涂阳病人的增多和新涂阳病人登记率的增高,主要是医疗单位的结核病人转诊病人数增加的结果。结论《湖南省结核病人归口管理工作规范》的实施方法与措施是一个可行的结核病人归口管理办法;做好结核病归口管理是提高病人发现率的有效措施。

Methodology Study on Implementation of Referring System of Pulmonary Tuberculosis in Hunan Province

Objective To explore the approach on implementation of the referral system between hospital system and the TB dispensary,to improve the case-finding level and establish a criterion of case-management. Methods A referral system was established between hospital and the TB dispensary system based on the local situation in Hunan Province.Compare the case-finding level and the source of TB case and suspect before and after the referral system implementation. Results During the same period of the referral system implementation foreand-aft,the consultation rate of TB suspects in county TB dispensary got an increment of 46.7% in 130 county TB dispensaries,and the referral rate of TB suspects from(county) hospitals increased by 146.8%.The registered new smear positive pulmonary TB cases increased by 73.8% and the(referral) rate of TB cases from county hospitals increasesd by 176.0%.The register rate of new smear-positive pulmonary TB reached to 44.0/10~5 in the project year while the register rate of new smear-positive pulmonary TB was(24.6/10~5) in other non-project year. Conclusion To improve the case-finding level of pulmonary TB,the referring system implementation is a feasible and effective strategy.