肺结核患者社区治疗管理调查分析

目的: 分析肺结核患者社区治疗管理情况,为进一步提高肺结核患者规则服药率、获得较好治疗转归提供科学依据。方法: 采用回顾性研究方法,选取2017年7月1日至2018年6月30日在北京市丰台区4家结核病定点医院诊断、治疗,并由25家社区卫生服务机构督导随访的228例已结案肺结核患者作为研究对象。收集社区卫生服务机构对患者开始督导、停止督导时间,定点医院记录的患者开始治疗、停止治疗时间,以及社区卫生服务机构和定点医院记录的复诊、中断治疗和药物不良反应发生情况;分析社区督导随访表和定点医院病历记录的以上信息的一致性。结果: 所有患者在社区接到督导通知后3个工作日内得到访视。患者的随访方式均为电话随访,督导人员均为家属。成功治疗203例(其中治愈60例,完成疗程143例),占89.0%。患者第1个月及第3~6个月的复诊率社区卫生服务机构记录分别为100.0%(228/228)、99.5%(221/222)、99.1%(215/217)、99.1% (209/211)、100.0%(209/209),定点医院病历记录分别为96.9%(221/228)、96.4%(214/222)、94.9%(205/216)、95.2%(198/208)、95.7%(198/207),差异均有统计学意义(Fisher精确概率检验,P值分别为0.016、0.036、0.004、0.004、0.004)。社区卫生机构督导记录中中途断药者9例(3.5%),定点医院记录中中途断药者20例(8.3%),差异有统计学意义(Fisher精确概率检验,P=0.014)。社区卫生机构记录发生药物不良反应者41例(18.0%),定点医院记录发生药物不良反应者68例(29.8%),差异有统计学意义(χ²=10.400,P=0.001)。70.2%(160/228)的患者在医院开始治疗5d内获得社区卫生机构督导服务,76.8%(175/228)的患者在定点医院停止治疗5d内社区卫生机构停止督导。结论: 肺结核患者在社区卫生服务机构和定点医院记录的复诊、断药和药物不良反应情况等信息不一致,应加强肺结核患者治疗和督导管理数据的信息化和双向传输,加强对结核病专科医院和定点医院信息录入、社区卫生服务机构患者随访的质量控制。

Survey on the community treatment and management of pulmonary tuberculosis patients

Objective: To survey the status of community treatment and management of pulmonary tuberculosis patients, to provide scientific basis for further improving the regular medication rate and getting better treatment outcome. Methods: A retrospective study was conducted in 228 pulmonary tuberculosis patients registered and managed in four designated hospitals from July 1, 2017 to June 30, 2018 and followed up by 25 community health service institutions in Fengtai District, Beijing. The time of start and stop supervision by the community health service institutions, the time of start and stop treatment for patients recorded by designated hospitals, and the subsequent revisit, interruption and adverse drug response recorded by community health service institutions and designated hospitals were collected. The consistency of the above information between the community follow-up record of the community health service institutions and the medical records of the designated hospitals was analyzed. Results: All patients were followed up by the community health service institutions within 3 working days of being notified. The patients were followed up by telephone, and all the supervisors were family members. Of them, 203 cases (89.0%) were successfully treated (60 cases were cured and 143 cases finished the course of treatment). The subsequent revisit rates at the first month and 3-6 months recorded by community health service institutions were 100.0% (228/228), 99.5% (221/222), 99.1% (215/217), 99.1% (209/211) and 100.0% (209/209), respectively and were 96.9% (221/228), 96.4% (214/222), 94.9% (205/216), 95.2% (198/208) and 95.7% (198/207) recorded in the designated hospitals, the differences were statistically significant (Fisher exact probability test, P=0.016, 0.036, 0.004, 0.004 and 0.004, respectively). Nine cases (3.5%) were recorded of drug interruption in community health service institutions and 20 cases (8.3%) were recorded in designated hospitals. The difference was statistically significant (Fisher exact probability test, P=0.014). There were 41 cases (18.0%) recorded of adverse drug response in community health service institutions and 68 (29.8%) cases were recorded in designated hospitals, the difference was statistically significant (χ²=10.400, P=0.001). Of the patients, 70.2% (160/228) received the supervision from the community health service institutions within 5 days after the start of treatment in hospitals, and 76.8% (175/228) of the patients received the supervision service from the community health service institutions within 5 days after the stop of treatment in the designated hospital. Conclusion: The information of subsequent revisit, drug interruption and adverse drug reactions recorded of tuberculosis patients by community health service institutions and designated hospitals were inconsistent. It is necessary to strengthen the informatization and two-way transmission of pulmonary tuberculosis patients’ treatment and supervision management data, as well as the quality control of information input in tuberculosis specialized hospitals and designated hospitals, and patients’ follow-up in community health service institutions.