Zhong Jieming, Yin Jia, Zou Guanyang, Hu Yanhong, Walley John, Wang Xiaomeng, Chen Songhua, Wei Xiaolin
TB department, Zhejiang Centre for Disease Control and Prevention, Hangzhou, 310051, China.
The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, N.T., China.
Trans R Soc Trop Med Hyg. 2016 Apr;110(4):246-51. doi: 10.1093/trstmh/trw001. Epub 2016 Feb 4.
This study aims to assess the implementation of the TB control program under the integrated model in China where TB diagnosis and treatment is provided in TB designated hospitals.
Six counties under the integrated model in Zhejiang were randomly selected. TB referral and tracing was analyzed based on routine TB reporting data between January and December 2009 from county TB dispensaries. Regarding treatment and community management, we conducted face-to-face surveys with 50 new TB patients randomly selected from each county, and reviewed their medical charts.
A total of 7090 persons with presumptive TB were reported in 2009, of whom, 66.7% (4732/7090) were referred by other health facilities to TB designated hospitals, while 80.2% (3795/4732) were successfully referred. In total, 301 patients were surveyed and had a median medical expenditure of US$192. Ten percent (31/301) missed at least one dose during their treatment, and 64.5% (194/301) received direct observation, mostly by family members.
The integrated model performed better on case referral and community management, but higher medical expenditures than those reported by studies under the dispensary model in China. Clear guidelines should be issued on supervising TB treatment in designated hospitals.
本研究旨在评估中国在综合模式下结核病防治规划的实施情况，该模式下结核病诊断和治疗在结核病定点医院进行。
随机选取浙江省采用综合模式的6个县。根据各县结核病防治所2009年1月至12月的结核病常规报告数据，对结核病转诊和追踪情况进行分析。关于治疗和社区管理，我们对每个县随机选取的50例新结核病患者进行了面对面调查，并查阅了他们的病历。
2009年共报告7090例疑似结核病患者，其中66.7%（4732/7090）由其他医疗机构转诊至结核病定点医院，80.2%（3795/4732）成功转诊。共对301例患者进行了调查，医疗费用中位数为192美元。10%（31/301）的患者在治疗期间至少漏服一剂药物，64.5%（194/301）的患者接受了直接督导，主要是由家庭成员进行督导。
综合模式在病例转诊和社区管理方面表现较好，但医疗费用高于中国结核病防治所模式下的研究报告。应出台关于结核病定点医院治疗督导的明确指南。
