湖北省石首市和巴东县肺结核患者就诊和卫生系统延迟情况及影响因素分析

  目的  对湖北省2个县（市）的肺结核病患者的就诊和卫生系统延迟情况进行调查，分析其影响因素，为结核病患者早发现，早治疗提供依据。  方法  采用横断面调查，通过现场面对面的询问和收集患者的病案信息、医院门诊记录和住院记录的方式调查患者的就诊和诊疗信息，应用单因素分析和多因素logistic回归分析进行影响因素分析。  结果  肺结核患者的就诊延迟中位数为7（P₂₅～P₇₅∶0～30）d，咳嗽或咳痰（OR=1.97，95%CI: 1.04～3.75），到达首次就诊医疗机构的距离>20 km （OR=2.35，95%CI: 1.36～4.06）为就诊延迟的危险因素，胸痛（OR=0.47，95%CI: 0.25～0.89）为就诊延迟的保护因素。 肺结核患者卫生系统延迟的中位数为24（P₂₅～P₇₅: 13～54）d，就诊次数和就诊的不同医疗机构数为患者卫生系统延迟的危险因素（P<0.05），且就诊次数和就诊的不同医疗机构数越多，结核病患者发生卫生系统延迟的风险越大。 肺结核患者总延迟的中位数为56（P₂₅～P₇₅: 26～138）d，咳嗽或咳痰（OR=2.37, 95%CI: 1.14～4.95），痰涂片阳性（OR=2.07, 95%CI: 1.16～3.68），到达最近结核病定点医疗机构距离>30 km（OR=1.92，95%CI: 1.04～3.55），就诊次数3～4次（OR=2.50，95%CI: 1.25～4.97）和就诊次数>4次（OR=25.42，95%CI: 5.19～124.44）均为患者总延迟的危险因素（P<0.05）。  结论  本研究中肺结核患者总延迟主要由卫生系统延迟造成，在采取有效措施减少患者就诊延迟的同时，还需要改善患者的就医行为，优化患者就医路径，提高非结核病定点医疗机构对结核病的警觉性和诊疗水平，发挥分子生物学检查等手段在患者筛查中作用，提高结核病诊断水平，减少患者卫生系统延迟。

Factors associated with health care-seeking delay and treatment delay in pulmonary tuberculosis patients in Shishou and Badong of Hubei

  Objective  To investigate the current status of health care-seeking delay and treatment delay of pulmonary tuberculosis (TB) patients and the influencing factors in two counties of Hubei Province, and provide evidence for the early detection and early treatment of TB patients.  Methods  Cross-sectional survey was conducted through face to face interview and collection of patient's medical record information, outpatient and inpatient records of hospitals for univariate analysis and logistic regression analysis to identify the factors independently associated with the health care-seeking delay and treatment delay.  Results  The median of health care seeking delay was 7 d (IQR: 0–30), the risk factors associated with health care-seeking delay were cough or expectoration (OR=1.97, 95% CI: 1.04–3.75), distance to a health facility for the first health care seeking >20 km (OR=2.35, 95% CI: 1.36–4.06), but chest pain (OR=0.47, 95% CI: 0.25–0.89) was the protective factor for health care seeking delay. The median of treatment delay was 24 days (IQR: 13–54), the number of health care seeking and number of different medical institutions visited were independent factors for treatment delay (P<0.05), the higher the numbers, the higher the risk for treatment delay. The median of total delay was 56 days (IQR: 26–138), the total delay was positively associated with cough or expectoration (OR=2.37, 95% CI: 1.14–4.95), being smear positive (OR=2.07, 95% CI: 1.16–3.68), distance to nearest designated TB medical institution >30 km (OR=1.92, 95% CI: 1.04–3.55), the number of health care seeking (3–4 times: OR=2.50, 95% CI: 1.25–4.97, >4 times: OR=25.42, 95% CI: 5.19–124.44).  Conclusion  In this study, the total delay of pulmonary TB patients was mainly caused by treatment delay. While taking measures to reduce health care seeking delay, it is still necessary to improve patient's health care seeking behavior, optimize patient access to medical institutions, improve the watchfulness and diagnosis level of TB of non-designated TB medical institutions and use molecular biology and other means for screening to reduce treatment delay of TB patients.