García Rodríguez J F, Mariño Callejo A, Lorenzo García M V, de Juan Prego J, Díaz Peromingo J A, Sesema Sánchez P
Servicio de Medicina Interna, Hospital A. Marcide-Novoa Santos, Ferrol, La Coruña.
Med Clin (Barc). 1997 Jun 7;109(2):45-8.
We determined the extent to which opportunities for prevention were missed among patients with tuberculosis and the costs derived from the lack of prevention.
Descriptive study of patients with active tuberculosis were studied in the hospital ward of tuberculosis at the A. Marcide-Novoa Santos Centre (Ferrol, Spain), from September of 1991 to August of 1995. Risk factors to develop tuberculosis, vaccination with BCG, previous tuberculin skin test and previous history of drug prophylaxis or tuberculosis therapy were determined. Then, we determined whether they had undergone prevention procedures in accordance with current recommendations of the American Thoracic Society. An evaluation of the direct and indirect derived costs was carried out in patients with any missed opportunity for tuberculosis prevention.
Out of 433 studied patients, 167 (38.6%) got missed any opportunity for prevention. Out of 167, 29 patients (6.7%) did not complete a previous treatment; 9 (2.1%) did not complete drug prophylaxis; 12 (2.8%) with known previous positive tuberculin skin test and an indication for drug prophylaxis never received it, and 117 (27%) with known indications for screening never received a skin test. 62 patients (53%) with known exposure to active pulmonary tuberculosis, and 65 (55.6%) with predisposing medical conditions. From the missed opportunities for prevention we calculated some direct costs of 116,909,911 pesetas and some indirect costs derived from the absence to work (141.9 +/- 114.3 days) and from the death of 6 patients for tuberculosis.
A large percentage of missed opportunities to prevent the disease was found among patients with tuberculosis. This means a considerable expense that could have been avoided.
我们确定了结核病患者中预防机会被错过的程度以及因缺乏预防措施而产生的成本。
对1991年9月至1995年8月期间在西班牙费罗尔的A. Marcide-Novoa Santos中心结核病医院病房的活动性结核病患者进行描述性研究。确定了患结核病的危险因素、卡介苗接种情况、既往结核菌素皮肤试验以及既往药物预防或结核病治疗史。然后，我们确定他们是否按照美国胸科学会的当前建议接受了预防措施。对任何错过结核病预防机会的患者进行了直接和间接衍生成本的评估。
在433名研究患者中，167名（38.6%）错过了任何预防机会。在这167名患者中，29名（6.7%）未完成先前的治疗；9名（2.1%）未完成药物预防；12名（2.8%）已知既往结核菌素皮肤试验呈阳性且有药物预防指征但从未接受过药物预防，117名（27%）已知有筛查指征但从未接受过皮肤试验。62名（53%）已知接触过活动性肺结核，65名（55.6%）有易患疾病。从错过的预防机会中，我们计算出直接成本为116909911比塞塔，以及因缺勤（141.9±114.3天）和6名患者死于结核病而产生的一些间接成本。
在结核病患者中发现有很大比例的预防疾病机会被错过。这意味着本可避免的相当大的费用。
