福建省山区农村DOTS策略执行现状分析

目的评价福建省山区农村DOTS策略执行现状。方法采用定量与定性相结合的方法，对肺结核病人问卷调查，并对知情人员及肺结核病人深入访谈，内容包括：结核病患者发现和治疗管理过程，相关部门对结核病控制的相关策略措施等；从政府承诺、病人发现过程、督导管理落实三方面分析评价。结果调查的3个县政府承诺落实较好；在村卫生室／私人诊所首次就诊的病人占53．5％，在结防机构的首次就诊仅占6．9％；有26．4％的病人就诊延迟，且59．9％的病人存在确诊延迟；94．9％的涂阳病人治疗过程中有医生上门访视，但72．9％的涂阳病人认为没有必要由医生看着吃药。仅有47．3％的病人在医务人员直接面视督导下服药。结论政府承诺及领导重视能保证结防工作顺利开展；应引导疑似肺结核病人和可疑症状者到结防机构就诊，提高归口管理工作的效率，减少卫生服务提供方造成的确诊延迟。直接面视下的短程督导化疗是DOTS策略的关键，应加强对村卫生室／私人诊所等乡村医生培训，提高认识，并制定适合我国农村地区并且符合医学伦理的策略。

Analysis of DOTS strategy implementation in rural and mountainous area in Fujian province

Objective To evaluate DOTS strategy implementation in rural and mountainous area in Fujian province. Methods A combined qualitative and quantitative methodology was used. Questionnaire survey was conducted to TB patients and in-depth interview was carried out among relevant persons and TB patients. The topics of the in-depth interview included case detection, treatment and management, TB control policies issued by relevant departments. The evaluation was conducted from three aspects which were governmental commitment to TB control, the process of care detection and the implementation of case supervision and management. Results The- governmental commitment to TB control implemented well in the three selected counties. 53.3 % patients selected the village clinic/private clinic as the first time of health care seeking and only 6.9 % patients selected TB dispensary in the first health care seeking. 26.4% patients delayed in seeking diagnosis while 59.9% patients experienced the delay in diagnosis confirmation. 94.9 % of smear positive patients were visited by doctors during the treatment, but 72.9% of smear positive cases believed that it was not necessary to be observed by doctors in drug taking. And only 47.3 % patients were directly observed the treatment by health care workers. Conclusion The governmental commitment could ensure the implantation of TB control. TB suspects and patients should be informed to visit TB dispensary for diagnosis. The effectiveness of referral should be improved and the delay in di- agnosis confirmation should be reduced. Directly observed treatment is the key point in DOTS strategy, thus the training to the township and village doctors should be enhanced to improve their awareness of TB and at the same time medical ethical policies adapted to the situation in rural area should be developed.