Sánchez-Pérez H J, Halperin Frisch David D
El Colegio de la Frontera del Sur, San Cristóbal de las Casas, Chiapas, México.
Aten Primaria. 1997 Mar 31;19(5):237-42.
To analyze critical factors in the diagnosis of pulmonary tuberculosis at both the primary and secondary levels, in the Border Region of Chiapas, Mexico.
A crossover study (from March to September, 1994)
Patients with chronic cough (n = 221) who sought care in the Out-patient Department of the only second level care hospital available in the region for the uninsured population. Each subject was interviewed, three sputum specimens were requested and the clinical charts reviewed.
Fourty-four patients were found positive for pulmonary TB of which six came to the hospital for initial care. 38 had already been seen in a primary care setting. Of those 38 only two had been diagnosed previously by acid fast smear. At the hospital level, the underdiagnosis of TBP was 9%.
The quality of care with regard to the diagnosis of pulmonary tuberculosis needs to be improved at both the primary and hospital levels. Health workers need to be sensitized to the symptomatology and trained to request sputum smears when indicated. The general population also needs to be educated with regard to pulmonary tuberculosis so as to demand better services.
分析墨西哥恰帕斯边境地区基层和二级医疗机构对肺结核诊断的关键因素。
一项交叉研究（1994年3月至9月）
在该地区唯一一家为未参保人群提供二级护理的医院门诊部就诊的慢性咳嗽患者（n = 221）。对每位受试者进行访谈，要求提供三份痰标本并查阅临床病历。
44例患者被发现肺结核呈阳性，其中6例是首次到该医院就诊。38例曾在基层医疗机构看过病。在这38例中，之前只有2例通过抗酸涂片被诊断出肺结核。在医院层面，肺结核的漏诊率为9%。
基层和医院层面在肺结核诊断方面的医疗质量都需要提高。医护人员需要对症状更加敏感，并接受培训以便在有指征时要求进行痰涂片检查。普通人群也需要接受关于肺结核的教育，以便要求获得更好的服务。
