地市级结核病定点医院耐多药肺结核诊断和治疗现状分析

目的 了解调查地区地（市）级结核病定点医院耐多药肺结核诊断和治疗现状，分析其在耐多药肺结核诊断和治疗方面存在的问题。 方法 采用访谈、问卷调查和病历调查相结合的方式，通过调查医院和访谈结核病控制关键人物了解地（市）级结核病定点医院耐多药肺结核服务提供情况；通过调查耐多药和疑似耐多药肺结核患者的住院病历了解患者住院期间接受的诊断和治疗服务情况，分析地（市）级结核病定点医院耐多药肺结核诊断和治疗过程中存在的问题。 结果 政府对5家医院的财政投入占医院总收入的比例在5.0%～30.2%不等，能开展药敏试验的医院所占比例仅为1/5。住院期间耐多药肺结核患者化疗方案规范率仅为13.3%，住院天数中位数为26 d，住院总费用10 893元，日均住院费用362.2元，住院费用自付费用比例59.0%，出院后转诊到结防机构的比例仅为6.6%。 结论 目前，政府对医院的财政投入较低，医院实验室耐多药肺结核的诊断能力较低。住院期间耐多药肺结核患者的化疗方案规范率较低，住院费用过高但医保报销比例低。出院后患者绝大部分没有及时转诊到当地结防机构，处于无人管理的自服药状态。

A cross-sectional study on Multidrug-resistant tuberculosis diagnosis and treatment in prefecture level designated TB hospitals

Objective The purpose of the study was to understand the status of multidrug-resistant tuberculosis（MDR-TB） diagnosis and treatment in prefecture level designated TB hospitals,to analyze problems existed in the process of MDR-TB diagnosis and treatment.Methods A cross-sectional study was conducted to understand the status of TB service delivery through key informant interview and tuberculosis hospitals investigation,to obtain medical diagnosis and therapy situation through inpatients＇ medical records investigation.Results The proportion of financial input by government in total hospital revenue ranged from 5.0% to 30.2% in five hospitals,among them only one out of five hospitals could carry out drug susceptibility test（DST）.During hospitalization periods,the standard chemotherapy rate was only 13.3% for multi-drug resistant tuberculosis patients,the median hospital stay was 26 days,the median hospitalization cost was 10 893 Yuan,average daily hospital expenses was 362.2 Yuan.The proportion of out of pockets fee by patient accounted for 59%.Only 6.6% of patients were transferred to TB institutions after hospital discharge.Conclusions At present,the hospitals received low government financial input,and their diagnosis capacity for MDR-TB is weak.The standard chemotherapy rate of MDR-TB patient is low during patients＇ hospitalization.In addition,the high hospitalization expenses are in compared with low reimbursement proportion.Most patients discharging from hospitals do not receive timely referral to local TB institutions.