Calder L, Gao W, Simmons G
Community Services, Auckland Healthcare, Auckland.
N Z Med J. 2000 Nov 24;113(1122):483-5.
First, to quantify the interval between the onset of symptoms and the start of anti-tuberculous treatment in a series of Auckland tuberculosis patients. Second, to examine the help-seeking behaviour of the patients and the responses of the health-care providers whom they consulted about their symptoms. Third, to identify potentially modifiable reasons for delayed presentation or diagnosis.
100 patients with tuberculosis (TB) were interviewed using a questionnaire which sought symptom duration and help-seeking behaviour. The doctors whom they consulted were surveyed about their diagnostic, therapeutic and referral responses.
Delayed presentation by patients ('patient delay') was found in smokers, patients who reported cough, patients who hoped their symptoms would go away on their own, and patients reporting fear of what would be found on diagnosis. 'Doctor delay' (the interval from first consultation with a doctor to start of treatment) was longer than that found in most published series and was a more important component of total delay than delayed presentation by patients. Longer doctor delay was found if patients had pre-existing lung disease or consulted multiple doctors, and if doctors did not inquire into past exposure to TB or request a chest X-ray.
Awareness programmes for high-risk communities are needed to encourage early reporting of symptoms. Continuing medical education for general practitioners is needed to encourage vigilance for TB and earlier use of diagnostic tests in patients who have symptoms of TB and are in high-risk groups.
第一，量化奥克兰一系列结核病患者症状出现至开始抗结核治疗之间的间隔时间。第二，研究患者的求医行为以及他们就症状咨询过的医疗服务提供者的反应。第三，确定导致就诊或诊断延迟的潜在可改变原因。
使用一份调查问卷对100例结核病患者进行访谈，该问卷旨在了解症状持续时间和求医行为。对他们咨询过的医生就其诊断、治疗和转诊反应进行调查。
在吸烟者、报告有咳嗽症状的患者、希望症状自行消失的患者以及报告害怕诊断结果的患者中发现了患者延迟就诊（“患者延误”）的情况。“医生延误”（从首次咨询医生到开始治疗的间隔时间）比大多数已发表系列研究中发现的时间更长，并且在总延误中比患者延迟就诊是更重要的组成部分。如果患者有既往肺部疾病或咨询过多个医生，以及如果医生未询问过去是否接触过结核病或未要求进行胸部X光检查，则会发现医生延误时间更长。
需要针对高危社区开展提高认识的项目，以鼓励早期报告症状。需要对全科医生进行继续医学教育，以提高对结核病的警惕性，并在有结核病症状的高危人群中更早地使用诊断测试。
