Kato Yukiko, Arimoto Azusa, Shimamura Tamae, Murashima Sachiyo
Citizen Health section, Kamakura City.
Nihon Koshu Eisei Zasshi. 2012 Apr;59(4):251-8.
As the number of tuberculosis (TB) cases has decreased, early diagnosis of TB has become more difficult. Delayed diagnosis of TB may lead to worsening of the affected individual's condition and may spread the disease in the community. The purpose of this study was to find factors associated with patient delay in seeking treatment after developing symptoms of TB.
Structured interviews were conducted with adult TB patients from 17 health centers registered under the national Japanese TB surveillance system from January 1, 2010 to November 30, 2010. The questionnaire used for the interview included items on symptoms, type of coping behavior from the time of onset of symptoms to the time of the first hospital visit, recognition of and experience with TB, priorities in terms of health behavior, and demographic characteristics of the patients.
Among the 60 patients interviewed, only 53 patients' data were analyzed. Seven patients were excluded from analysis because they had no symptoms, were non-Japanese, had extrapulmonary tuberculosis, or were undergoing retreatment. The mean age of the patients was 60.2 +/- 19.2 (mean +/- SD) years. Twenty-two patients (41.5%) visited a hospital after a gap of more than two months from the time of onset of their symptoms (hereafter referred to as "patient delay"). Factors associated with patient delay were presence of sputum and hemoptysis, positive sputum smear, low priority given to health, lack of a family physician, lack of consultation, taking over-the-counter drugs, and disliking hospital visits.
Factors associated with patients' seeking medical treatment more than two months after developing symptoms of TB included taking over-the-counter drugs disliking hospital visits and not consulting health professionals or the people around them. In order to prevent patient delay, our findings suggest the following actions. Health care professionals need to provide information about symptoms of tuberculosis and the merits of early hospital visits to patients. It is also necessary for health care professionals in public health centers, etc., to communicate the need to have people available whom patients can consult regarding their symptoms and receive appropriate advices or secure appropriate treatment when they have symptoms of tuberculosis.
随着结核病病例数量的减少，结核病的早期诊断变得更加困难。结核病的延迟诊断可能导致患病个体病情恶化，并可能在社区中传播疾病。本研究的目的是找出与结核病患者出现症状后延迟就医相关的因素。
对2010年1月1日至2010年11月30日在日本国家结核病监测系统登记的17个医疗中心的成年结核病患者进行了结构化访谈。访谈使用的问卷包括症状、从症状出现到首次就诊期间的应对行为类型、对结核病的认识和经历、健康行为的优先事项以及患者的人口统计学特征等项目。
在接受访谈的60名患者中，仅对53名患者的数据进行了分析。7名患者被排除在分析之外，因为他们没有症状、不是日本人、患有肺外结核病或正在接受再治疗。患者的平均年龄为60.2±19.2（平均值±标准差）岁。22名患者（41.5%）在出现症状后两个多月才去医院就诊（以下简称“患者延迟”）。与患者延迟相关的因素包括咳痰和咯血、痰涂片阳性、对健康的重视程度低、没有家庭医生、没有咨询、服用非处方药以及不喜欢去医院就诊。
与结核病患者出现症状后两个多月才就医相关的因素包括服用非处方药、不喜欢去医院就诊以及未咨询医疗专业人员或周围的人。为了防止患者延迟，我们的研究结果建议采取以下行动。医疗保健专业人员需要向患者提供有关结核病症状以及早期就诊益处的信息。公共卫生中心等机构的医疗保健专业人员也有必要宣传，当人们出现结核病症状时，需要有可供咨询的人员，以便获得适当的建议或确保得到适当的治疗。
