上海市闵行区肺结核患者卫生服务需要与利用情况分析

目的 分析上海市闵行区肺结核患者卫生服务需要与利用情况，评价卫生服务利用的影响因素。 方法 上海市闵行区2010年共建立1 286 830份电子健康档案，其中749例登记肺结核专档。 以这749例肺结核患者和其中502例已治愈患者作为研究对象，分析其流行病学和疾病管理、卫生服务需要与利用情况，并针对肺结核患者卫生服务利用情况进行单因素和多因素logistic回归分析。 结果 2010年上海市闵行区建档人群的肺结核患病率为58.21/10万，活动性肺结核（菌阳）患病率为30.62/10万，慢性病患病率为51.54%（386/749）。其中，治愈和满疗程的502例患者的人均就诊次数、检测检验次数和受访视次数分别为2.74、9.02和5.47次。年龄在65岁以上（β值=－2.513，Wald χ²值=0.508，P值=0.000，OR（95.0% CI）值=0.081（0.030~0.219））、因肺结核和其他慢性病就诊（β值=－3.987，Wald χ²值=0.458，P值=0.000，OR（95.0% CI）值=0.136（0.047~0.491））使得肺结核患者就诊次数增加。 结论 上海市闵行区肺结核患者对区域卫生服务需要量较高，利用率较低。肺结核患者的防控工作要针对不同人群开展针对性的防治措施，掌握他们的卫生服务需要，提高其卫生服务利用水平。

Analysis of needs and utilization of health services in patients with pulmonary tuberculosis in Minhang district,Shanghai

Objective To analyze the needs and utilization of health service in patients with pulmonary tuberculosis in Minhang district of Shanghai city,and evaluate the factors influencing the utilization of health service. Methods In 2010,a total of 1 286 830 copies of electronic health records were established in Minhang district,of which 749 were records specially for registered pulmonary tuberculosis.These 749 pulmonary tuberculosis cases and 502 patients among them which have been cured were taken as research subjects to analyze their epidemiological and management information,the needs and utilization of health service for tuberculosis patients.Univariate and multivariate logistic regression analysis was made to analyze the factors affecting their health service utilization. Results Among the filing population in Minhang district in 2010,the prevalence of pulmonary tuberculosis was 58.21/100 000,the prevalence of active pulmonary TB(sputum positive) was 30.62/100 000,and the prevalence of chro-nic diseases was 51.54%(386/749).Among the 502 cases who have been cured or have completed the full-course treatment,the frequency of clinic visits,laboratory examinations,and DOT supervisions in terms of times were 2.74,9.02 and 5.47 times respectively.Patients older than 65 years(β=-2.513,Wald χ2=0.508,P=0.000,OR(95.0%CI)=0.081(0.030~0.219)),with pulmonary tuberculosis and other chronic diseases(β=-3.987,Wald χ2=0.458,P=0.000,OR(95.0% CI)=0.136(0.047~0.491)) are more likely to increase the frequency of clinic visits. Conclusion The patients with pulmonary tuberculosis in Minhang district have a high requirement for health services,however,the utilization is adversely low.We should carry out targeted prevention measures for different groups of people,grasp their needs of health service,and improve their health services utilization.