重庆市医疗机构对肺结核患者发现的贡献作用

目的 通过分析重庆市医疗机构网络报告肺结核疫情及转诊和到位确诊患者情况,评价医疗机构在提高患者发现中的贡献作用.方法 通过重庆市各县区的结核病控制工作月报表和结核病管理信息系统获得重庆市2006-2015年医疗机构网络直报的肺结核疫情数和确诊的肺结核患者数,采用x2检验对不同年份、不同类别医疗机构的报告水平和确诊患者进行分析.结果 2006-2015年全市医疗机构累计网络直报实际肺结核疫情323 603例,报告数逐年上升.转诊到位率低于全国平均水平,且近年来呈下降趋势.通过医疗机构网络报告总体到位率逐年提高,活动性肺结核患者贡献率由2006年的10.14％上升至2015年的52.09％(x2=25 610.75,P＜0.01),涂片阳性肺结核患者贡献率由2006的6.42％上升至2015年的52.46％(x2=10 520.65,P＜0.01),耐多药肺结核患者贡献率为44.9％.市级综合医院、县区级综合医院等发现的患者逐年增加(P＜0.01).医疗机构来源的患者发现延误中位数为56 d,延误率为79.62％.结论 医疗机构对肺结核患者的发现贡献逐渐增大,但该部分患者的发现延误情况严重.

The contribution of medical institutions to pulmonary tuberculosis detection in Chongqing city

Objective To evaluate the contribution of medical institutions in improving pulmonary tuberculosis(PTB) casefinding by analyzing the referral and diagnosis situation of PTB reported by medical institutions.Methods Thenumber of pulmonary tuberculosis cases and the number of tuberculosis patients diagnosed by the network of medical institutions in Chongqing from 2006 to 2015 were obtained by monthly report of tuberculosis control work and Tuberculosis Management Information System in Chongqing county districts,x2 test was used to analyze the reporting level and number of confirmed case with different year and different types of medical institutions.Results PTB or suspected PTB reported by medical institutions though network were 323 603 cases,which showed a upward trend year by year.The referral arrival rate was lower than national average level,and showed a downward trend in recent years.The proportion of confirmed PTB patients reported by medical institutions was found to increase year by year.Contribution rate of active PTB was increased from 10.14％ in 2006 to 52.09％ in 2015(x2 =25 610.75,P＜0.01),and contribution rate of smear positive PTB patients was increased from 6.42％ in 2006 to 52.46％ in 2015(x2 =10 520.65,P＜0.01).Contribution rate of multi-drug resistant PTB patients was 44.9％.Patients found by Municipal or County General Hospital was increased year by year(P＜0.01).The delay time of patients form medical institutions was 56 days,and the average delay rate patient was 79.62 ％.Conclusion The contribution of medical institutions to PTB case-finding is increasing,but the situation of delay is serious.