Sanz B, Blasco T
National Centre of Tropical Medicine, Instituto de Salud Carlos III, Madrid, Spain.
Int J Tuberc Lung Dis. 2007 Jun;11(6):639-46.
To identify variables associated with total diagnostic delay (TDD), patient delay (PD) and health service delay (HSD), among the tuberculous immigrant population in the Autonomous Community of Madrid (ACT).
Tuberculosis cases diagnosed in 15 hospitals in the ACT in 2003 were interviewed face-to-face and medical records were reviewed. A descriptive study was conducted, followed by univariate and multivariate analysis using non-conditional logistic regressions. 50th (p50) and 75th (p75) percentiles of the different diagnostic delay components were analysed as dependent variables.
For the 296 cases included, the mean TDD was 40.5 days (IQR 16.0-90.0), the PD was 15 days (IQR 6.5-30.0), and the HSD was 5 days (IQR 0.0-30.0). TDD-p75 is associated with seeking primary health care (OR 2.87, 95%CI 1.47-5.58). PD-p75 is associated with identification of fever (OR 0.49, 95%CI 0.25-0.92) and non-identification of cough (OR 1.87, 95%CI 1.05-3.36) as symptoms resulting in health care being sought. The HSD-p75 is associated with primary health care being sought (OR 3.81, 95%CI 1.87-7.78), health cover (OR 15.07, 95%CI 1.96-115.68) and negative smear results at the time of diagnosis (OR 1.98, 95%CI 1.01-3.91).
The HSD needs to be reduced, mainly when health care is sought through the primary care services and among patients with negative smear results.
确定与马德里自治区（ACT）结核病移民人群的总诊断延迟（TDD）、患者延迟（PD）和卫生服务延迟（HSD）相关的变量。
对2003年在ACT的15家医院诊断出的结核病病例进行面对面访谈，并查阅病历。进行了描述性研究，随后使用非条件逻辑回归进行单变量和多变量分析。将不同诊断延迟成分的第50百分位数（p50）和第75百分位数（p75）作为因变量进行分析。
纳入的296例病例中，平均TDD为40.5天（四分位间距16.0 - 90.0），PD为15天（四分位间距6.5 - 30.0），HSD为5天（四分位间距0.0 - 30.0）。TDD - p75与寻求初级卫生保健相关（比值比2.87，95%置信区间1.47 - 5.58）。PD - p75与将发热识别为促使寻求医疗保健的症状相关（比值比0.49，95%置信区间0.25 - 0.92）以及与未将咳嗽识别为促使寻求医疗保健的症状相关（比值比1.87，95%置信区间1.05 - 3.36）。HSD - p75与寻求初级卫生保健相关（比值比3.81，95%置信区间1.87 - 7.78）、医保相关（比值比15.07，95%置信区间1.96 - 115.68）以及诊断时涂片结果为阴性相关（比值比1.98，95%置信区间1.01 - 3.91）。
需要减少HSD，主要是在通过初级保健服务寻求医疗保健时以及涂片结果为阴性的患者中。
