村医集中推荐肺结核可疑症状者检查对提高新涂阳肺结核发现率的研究

目的探讨病人主动发现的新途径,提高新涂阳肺结核发现率。方法选择2003年新涂阳登记率低于全省平均水平的30个县,由经过培训的乡村医生对肺结核可疑症状者进行摸底调查,集中组织他们到县结防科或附近的乡镇、综合医院痰检点进行免费查痰。同时,县结防科对其他非结防机构网络直报但未前来就诊的肺结核和疑似肺结核病人进行追踪调查。结果2004年11月至2005年10月,30个县共发现新涂阳肺结核病人12 091例,新涂阳登记率由项目实施前的36.21/10万,提高到49.94/10万(χ²=101.7,P<0.000 1),发现率达到86.0%。30个县共登记肺结核可疑症状者43 464例,其中村医集中推荐15 363例,占35.3%,村医推荐发现新涂阳病人3 870例,占新涂阳病人发现总数的32.0%。县结防科对传染病网络直报病人的追踪率为70.9%,追踪到位率仅33.1%。结论利用村医集中推荐肺结核可疑症状者到县结防科检查,并给予一定的激励机制,是提高病人发现的有效方法之一。

Increase case detection of TB through intensive referral of TB suspects by village doctors to county TB dispensary

Objective To explore the new approach to increase case detection of pulmonary tuberculosis(TB). Methods 30 counties whose case registration rates were lower than the average in Hubei province in 2003 were selected in this project.Patients with TB symptoms were inquired and referred by trained village doctors to county dispensaries, designated township health centers or general hospitals for free sputum examination.At the same time,TB patients and suspects notified by general hospitals were traced by TB staff via phone call,letter,etc.if they were defaulted during the referring. Results From Nov 2004 to Oct 2005,12 091 new smear positive TB cases were detected in the 30 counties.The new smear positive registration rate increased from 36.21/100,000 to 49.94/100 000(χ²=101.7,P<0.0001) and the case detection rate under DOTS reached 86.0%.Among 43 464 suspects registered with TB symptoms in 30 counties,15 363(35.3%) patients were referred by village doctors,in which 3 870 were new smear positive TB cases,accounting for 32.0% of the total.The follow-up rate was 70.9%,and arrival rate of the traced cases was only 33.1%. Conclusion It is an effective way to increase case detection through intensive referral of patients with TB symptoms by village doctors to TB dispensary with some incentives to patients and village doctors.