藏区非结防医生结核疑似病人确诊延迟分析

目的 探讨四川省藏区非结核病防治机构医生对结核疑似病人确诊延迟的影响。方法 通过问卷收集初次到若尔盖和石渠县结防机构诊治的结核疑似病人的资料，调查首诊为非结防机构医生的结核疑似病人确诊延迟情况。结果 80．0％结核疑似病人首诊选择非结防机构医生，且其中最后被结防机构确诊为活动性肺结核的42例患者中，54．8％发生了确诊延迟；不同类非结防机构医生在各自接诊的病人中，藏医首诊结果怀疑结核病的比例低于个体医生、乡村医生与县级医生等（P〈0．001）；首诊选择藏医的结核疑似病人确诊延迟发生率高于选择乡村医生和县级医生等的（P=0．008）；未被非结防医生推荐到结防机构就诊者较被推荐者确诊延迟发生率高（P〈0．001）。结论 非结防机构医生的类型、首诊结果及其是否推荐结核疑似病人到结防机构就诊与结核疑似病人的确诊延迟有关；培训非结防机构医生的结核病知识、加强归口管理可减少结核疑似病人的确诊延迟。

Effect of non-anti-tuberculosis organs doctors on doctor delay of suspected tuberculosis cases in Sichuan Tibetan community

Objective To explore the impact of the doctors of non-anti-tuberculosis organs on the doctor delay of suspected tuberculosis(TB)cases.Methods Questionnaire was used for data collection.The doctor delay of the suspected TB cases were described as people who firstly sought the doctors of non-anti-tuberculosis organs.Results 80.0% cases of the suspected TB firstly sought the doctors of non-anti-tuberculosis organs,moreover 54.8% cases of active pulmonary TB had the doctor delay in these cases.The proportion of suspected TB in Tibetan doctors'first diagnosis results was smaller than that of private doctors,village doctors and county hospital doctors and so on(P<0.001).The delay incidence of Tibetan doctor was higher than that of village doctors and county hospital doctors ect(P=0.008).The delay incidence of the cases un-recommended for anti-tuberculosis organs by doctors was higher than that of recommended the cases(P<0.001).Conclusion The types and the first diagnosis results of non-anti-tuberculosis doctors and whether or not these doctors recommended cases for anti-tuberculosis organs,were association with the doctor delay.Improving the non-anti-tuberculosis organs doctors'TB knowledge and strengthening the centralized management measure can decrease the doctor delay.