在中国农村地区，与非县级结核病定点医院相比，县级结核病定点医院为结核病患者提供了更好的治疗。

Better care provided to patients with tuberculosis at county designated TB hospitals (CTD) compared to non-CTDs in rural China.

作者信息

Yuan Li, Zhang Hui, Zhou Changming, Jiang Weili, Zhao Qi, Biao Xu

机构信息

Department of Epidemiology, School of Public Health, Fudan University, 138 Yi Xue Yuan Rd, Shanghai, 200032, China.

Key Laboratory of Public Health Safety (Ministry of Education), 138 Yi Xue Yuan Rd, Shanghai, 200032, China.

出版信息

BMC Infect Dis. 2017 Jan 13;17(1):71. doi: 10.1186/s12879-016-2108-8.

DOI:10.1186/s12879-016-2108-8

PMID:28086753

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5237123/

Abstract

BACKGROUND

The primary unit of tuberculosis (TB) medical care in China is the county TB dispensary or county designated hospital (CTD), where patients can receive free diagnosis and treatment. However, a substantial number of patients seek their anti-TB treatment from general health facilities (Non-CTDs). This study aimed to investigate the first anti-TB treatment experience and choice of health facilities of retreated TB patients and their determinants.

METHODS

A cross-sectional study was conducted in Jiangsu, Shandong and Sichuan provinces. All registered re-treated TB patients were investigated using a structured questionnaire covering information on demographics, socio-economic characteristics, and previous anti-TB treatment experiences.

RESULTS

Totally, 75.3% of 544 patients visited CTD directly for initial treatment. Patients who were female (OR:1.71, 95% CI: 1.01-2.87), over 40 years of age (OR:2.80, 95% CI: 1.24-6.33), from Jiangsu (OR:3.07, 95% CI: 1.57-6.01) and Sichuan (OR:4.47, 95% CI: 2.29-8.73) and those diagnosed before 2005 (OR:6.87, 95% CI: 4.24-11.13) had a significant higher risk receiving their initial treatment at a non-CTD. Patients were more likely to have standardized diagnosis and treatment regimens in CTD (89.8%) than in non-CTDs (65.9%). Patients treated in non-CTDs versus in CTD had a lower possibility to complete their treatment course during first TB episode (χ = 3.926, P = 0.048), but there was no significant difference in the cure rate between different facilities (CTD 60.8%, Non-CTDs 59.1%). Patients in non-CTDs incurred higher costs (1,360 CNY) than those treated in CTD (920CNY).

CONCLUSION

CTD play a key role in the National Tuberculosis Control Program. Patients should be guided to seek health care in county designated hospital, where they are more likely to receive appropriate examinations, treatment regimens and rigorous supervision, and to bear a lighter economic burden.

摘要

背景

在中国，结核病医疗的主要单位是县级结核病防治所或县级指定医院（CTD），患者可在那里接受免费诊断和治疗。然而，相当多的患者在普通医疗机构（非CTD）寻求抗结核治疗。本研究旨在调查复治结核病患者首次抗结核治疗的经历、对医疗机构的选择及其决定因素。

方法

在江苏、山东和四川三省开展了一项横断面研究。使用结构化问卷对所有登记的复治结核病患者进行调查，问卷涵盖人口统计学、社会经济特征以及既往抗结核治疗经历等信息。

结果

在544例患者中，共有75.3%的患者首次治疗时直接前往CTD。女性患者（比值比：1.71，95%置信区间：1.01 - 2.87）、年龄超过40岁的患者（比值比：2.80，95%置信区间：1.24 - 6.33）、来自江苏的患者（比值比：3.07，95%置信区间：1.57 - 6.01）和四川的患者（比值比：4.47，95%置信区间：2.29 - 8.73）以及2005年前被诊断的患者（比值比：6.87，95%置信区间：4.24 - 11.13）在非CTD接受首次治疗的风险显著更高。与非CTD（65.9%）相比，患者在CTD更有可能接受标准化的诊断和治疗方案（89.8%）。在非CTD接受治疗的患者与在CTD接受治疗的患者相比，在首次结核病发病期间完成治疗疗程的可能性较低（χ² = 3.926，P = 0.048），但不同医疗机构之间的治愈率没有显著差异（CTD为60.8%，非CTD为59.1%）。在非CTD接受治疗的患者产生的费用（1360元人民币）高于在CTD接受治疗的患者（920元人民币）。