缺少医疗服务肺结核患者发现比例变化与分析

目的 分析新涂阳肺结核病例中缺少医疗服务的肺结核患者发现的比例变化，评价其发现水平与病例发现的关系。方法 对湖南省实施的国际防痨和肺部疾病联合会合作项目中新涂阳肺结核病例登记月报表进行统计。分析项目地区不同来源发现的新涂阳肺结核病例中缺少医疗服务的肺结核患者的比例与变化趋势，比较项目地区在两轮项目实施中发现的新涂阳肺结核病例中缺少医疗服务的肺结核患者的比例的变化。结果 在第一轮项目中，新涂阳肺结核病例中缺少医疗服务患者的比例为87．9％，随着时间的推移，该比例有增高的趋势。不同来源病例中，医院机构转诊发现的新涂阳肺结核病例中缺少医疗服务患者的比例为88．5％，肺结核可疑症状者就诊发现新涂阳肺结核病例中缺少医疗服务患者的比例为87．5％。不同来源病例发现比例元差别（P〉0．05）。在第二轮项目中，缺少医疗服务患者的比例为56．2％，明显低于第一轮患者的比例（P〈0．05）。结论 新涂阳肺结核病例中缺少医疗服务患者的比例，随着项目的不断扩展和深入，比例明显减少。显示出通过加强肺结核病例的转诊和就诊，肺结核病例登记率增高，病例发现延误减少，缺少医疗服务患者的比例减少。

Proportion changing and analysis of case detection of pulmonary tuberculosis patients with limited access to health care

Objective To analysis the proportion changing of PTB patients with limited access to health care,and evaluate the relationship between the level of detecting limited access patients and the level of case detection of new smear positive.Methods To analyze the monthly report from Hunan Province FIDELIS project and analyze the trend of proportion of those limited access patients among the new smear positive from different sources which contribute to the case detection of new smear positive,and to compare this proportion in the 2 round projects.Results In the first round project,the proportion of limited access patients in new smear positive was 87.9%.And there was a trend towards higher proportion with longer implementation of the project.Among those who were referred from general hospital,the patients who were limited to health care accounted for 88.5%;among those who sought to treat in TB dispensaries by themselves,the patients who were limited to health care account for 87.5%;there was no significance difference between patients coming from difference sources(P>0.05).In the second round project,the proportion of limited access patients in new smear positive was 56.2%,which was significantly lower than corresponding rate of the first round(P<0.05). Conclusion With the progress of the project,the proportion of limited access patients to health care in new smear positive patients remarkably decreased,which showed that through the strengthening the referral management of patients from general hospital to the TB dispensaries,the case registration rate increased,and detection delay was reduced,and the proportion of limited access to health care patients decreased.