贫困县结核病防治不同管理模式实施效果

目的评价贫困县不同结核病防治管理模式实施效果。方法对不同结核病防治管理模式的隆安县(定点医院模式)和上林县(疾控模式)2008年结核病季报表和年度报表进行分析;采用随机抽样方法,从隆安和上林县的新发涂阳患者中分别抽取62例和60例研究对象进行问卷调查。结果 2008年隆安县涂阳患者登记率47.88/10万高于上林县32.07/10万,差异有统计学意义(P<0.01);隆安县新发涂阳患者二月末转阴率96.7%,高于上林县的88.3%,差异有统计学意义(P<0.01);2县治愈率相比差异无统计学意义;隆安县中断治疗比例6.5%,与上林县21.7%相比,差异有统计学意义(P<0.05);两种模式下患者治疗的经济负担均较重。结论定点医院模式提高了病人发现率,在病人的治疗管理上优于疾控模式,建议逐步推广定点医院模式,但需对定点医院予以一定的经费补偿。

Implementation Effectiveness of Different Management Models on Tuberculosis Control and Prevention in Poverty - stricken Counties

Objective To evaluate the implementation effectiveness of different management models on tuberculosis control and prevention in poverty-stricken counties. Methods Two poverty-stricken counties（Longan and Shanglin） were selected as the study sites,the management of tuberculosis patients complied with the designated？hospital model for the former and the traditional model for the latter.The data were extracted and analyzed from quarterly reports and annual reports of the two counties in 2008.The simple random sampling method was used to select 62 and 60 newly diagnosed sputum-smear positive pulmonary TB patients from Longan and Shanglin Counties respectively,and the data were collected by questionnaires. Results The registration rate of sputum smear-positive TB patients in Longan County in 2008 was significantly higher than that in Shanglin County（47.88/100,000 vs 32.07/100,000）,and the difference was statistically significant（P〈0.01）.The negative conversion rate at two-month follow-up of new smear-positive TB patients in Longan County was 96.7%,which was higher than that in Shanglin County （88.3%）,and the difference was statistically significant（P〈0.01）.No statistically significant difference was found in the curative rate between the two counties.The proportion of patients with interruption during the treatment period in Longan County was 6.5%,which was significantly lower than that in Shanglin County（21.7%）,and the difference was statistically significant（P〈0.05）.The economical burden due to tuberculosis was heavy in both counties. Conclusions The designated？hospital model effectively increases the discovery rate of TB patients,and also has an advantage over the tradition model on patients＇ treatment and management.It is reasonable to extend the designated？hospital model gradually,and moreover,the financial aid for the designated？hospitals should be emphasized.