重庆地区肺结核患者诊疗延迟及影响因素分析

目的了解重庆沙坪坝区及万州区肺结核患者就医行为,分析肺结核患者就诊延迟和确诊延迟情况,并探索其相关影响因素。方法对233名结核病患者采用问卷调查收集相关数据。采用Logistic回归分析影响因素。结果42.9%的结核病患者初次就诊会选择县市级医院。76例（32.6%）患者发生就诊延迟现象,平均延迟83.4d,就诊延迟天数中位数为40d。多因素回归分析结果显示60岁以上的患者更容易发生就诊延迟[OR95%C.I：4.337（2.078,9.052）]。40.3%的患者出现了确诊延迟,确诊延迟4周及以上占大多数。多因素回归分析结果表明年龄和初次就诊医疗机构选择对确诊延迟有影响：60岁以上年龄段[OR6.306 95%C.I：（2.72,14.617）]出现确诊延迟的危险性最高;初次就诊医疗单位选择在乡镇卫生院/社区卫生服务中心[OR9.343 95%C.I：（2.158,40.441）]、其他如民营医院等[OR6.997 95%C.I：（1.712,28.601）],发生确诊延迟危险性远远高于县市医院。结论结核患者就诊延迟、确诊延迟依然严重。要通过加大结核病防治知识的宣传力度,加强对结核病防治工作医务人员的专业培训等工作减少诊疗延迟的发生。要特别重视老年结核病患者的早发现、早诊断工作。

Factors influencing patients delay and diagnosis delay of tuberculosis patients in Chongqing area

Objective To investigate the factors influencing the patients delay and diagnosis delay of TB patients in Chongqing,. Methods A questionnaire survey of 233 TB patients was carried out in Chongqing area. Results There 42.9% of TB patients chose county hospitals as their first health facility for consultation after TB symptoms appeared. Diagnosis delay occurred to76 TB patients （32.6%）.The average patients delay was 83.4 days, and the median was 40 days. Results of Logistic regression analysis shows that delay would much likely to occur to patients I〉 60 years old in health care seeking[OR= 4.337,95% CI：（2.078,9.052）]. 40.3% of TB patients had diagnosis delay and the majority experienced the diagnosis delay of over 4 weeks. Results of Logistic regression analysis indicated that age and health facilities for the first visit were associated with diagnosis delay： TB patients t〉 60 years old and the first consultation in township hospitals/community health centers were risk factors for diagnosis delay[OR 6.306,95% CI： （2.72,14.617）land 9.343 （2.158,40.441）] respectively. Conclusions There were patients delay and diagnosis delay of TB patients in Chongqing, particularly for the elderly. To improve TB health promotion, and professional training for health workers are key measures to reduce both patients delay and diagnosis delay.of TB patietns