上海市"三位一体"结核病防治模式成效初探

目的分析和评价上海市结核病“三位一体”防治新模式的运作机制和成效,探讨大城市结核病防治工作的可持续发展。方法上海市于1999年起建立和完善由疾病预防控制中心、结核病定点医院、社区卫生服务中心组成的结核病“三位一体”防治模式,疾病预防控制中心全面实行归口管理,定点医院承担归口诊治,社区卫生服务中心落实防治措施。本文就1995—2004年新模式建立前后的结核病防治成效进行比较和评价。结果1995—2004年,全市综合性医院发现的活动性肺结核患者数增加了68．7％,由1995年的2549例增加到2004年的429 9例,本市居民新登记活动性患者中,由综合性医院发现的比例也由1995年的43．1％上升至2004年的51．0％,全市综合性医院发现的疑、确诊肺结核病例报告率1997年为96．3％,1998—2004年均在99％左右,全市新登记涂阳病例6个月阴转率无明显差别,均在90％左右。全市1994—2003年新登记活动性病例1年治愈率除1998年外均保持在90％以上,全市新登记活动性病例社区管理覆盖率逐步提高,由1995的93．7％提高至2004年99．2％。1995—2004年活动性病例规则服药率均保持在96％-98％左右,且有上升趋势。结论在政策、经费、制度和质量保障下,上海市“三位一体”结核病防治模式已取得良好成效。

The effectiveness of the new TB control network in Shanghai

Objective To evaluate the effectiveness of the new TB control network in Shanghai and to discuss the sustainable development of TB control in metropolis of China. Methods The current network of TB control in Shanghai, which was established in 1999, consists of CDC, designated TB hospital and community health services center. The effectiveness of the new network of case finding, report and register, diagnosis and treatment and management was analyzed and compared with that of old network. Results The number of active pulmonary TB cases found in all general hospitals in Shanghai increased 68.7% from 2 549 in 1995 to 429 9 in 2004, and the proportion of newly-registered cases among local residents found in general hospitals increased from 43.1% in 1995 to 51.0% in 2004 Ninety six of all suspected or diagnosed TB cases were reported in 1997, and remained around 99% during 1998-2004. The six-month bacillus conversion rate of newly-registered smear positive TB cases showed no significance difference during 1994-2003, remaining around 90% . The one-year cure rate of active pulmonary TB cases was more than 90% for each year except for 1996. The community case-management coverage rate of active TB cases increased from 93.7% in 1995 to 99.2% in 2004. The regular drug-intake rate of active TB cases showed the trend of increasingduring 1995-2004. Conclusion With the supports of policy, finance, organization and quality assurance, the new network of TB control in Shanghai had improved the effectiveness of TB control in Shanghai.