中华预防医学杂志
中華預防醫學雜誌
중화예방의학잡지
CHINESE JOURNAL OF
2011年
1期
30-35
,共6页
徐广保%刘飞鹰%冯启明%梁馨元%苏莉
徐廣保%劉飛鷹%馮啟明%樑馨元%囌莉
서엄보%류비응%풍계명%량형원%소리
结核,肺%疾病管理%农村卫生%评价研究
結覈,肺%疾病管理%農村衛生%評價研究
결핵,폐%질병관리%농촌위생%평개연구
Tuberculosis,pulmonary%Disease management%Rural health%Evaluation studies
目的 探索有效的农村肺结核病防治管理新模式,为农村社区肺结核病防治策略的制定提供科学依据.方法 于总人口为67.9万人的广西兴业县,在县级结核病防治机构肺结核诊疗服务可及性差的农村乡镇中,选择人口数合计为152 518人的交通不便的4个乡镇作为实验组,开展以乡镇卫生院为诊疗管理中心、按社区服务可及性设服务点、聘请家庭督导员协助督导的农村肺结核病防治管理新模式的项目研究,项目基线及终期肺结核病例数分别为44例和117例;同时在该县选择条件类似、人口数合计为133 303人的大平山镇、龙安乡和高峰镇作为对照组.对照组开展现行国家结核病防治规划规定的县级结核病诊疗管理模式,基线及终期肺结核病例数分别为56例和110例.采用双向比较方法从肺结核患者发现情况、患者治疗转归情况和结核病控制工作管理情况等方面评价新模式的效果.采用SPSS 13.0统计软件进行统计分析,计数资料的组间比较采用x2检验.结果 经过2年的项目实施,项目实施前后实验组肺结核患者涂阳新登记率从16.39/10万(25/152 518)提高到51.14/10万(78/152 518)(x2=27.281,P<0.01);初治涂阳患者治愈率从71.4%(15/21)提高到91.1%(51/56)(x2=4.812,P<0.05);初治涂阴患者完成疗程率从23.5%(4/17)提高到71.4%(15/21)(x2=8.622,P<0.01);初治涂阳患者丢失率从23.8%(5/21)下降为0.0%(0/56)(x2=10.608,P<0.01);初治涂阴患者丢失率从64.7%(11/17)下降为4.8%(1/21)(x2=15.624,P<0.01).项目终期,实验组的初治涂阳患者治愈率[91.1%(51/56)]高于对照组的治愈率[72.0%(36/50)](x2=6.531,P<0.05),而初治涂阳病例丢失率[0.0%(0/56)]低于对照组[16.0%(8/50)](x2=7.534,P<0.01);项目实施期间实验组患者的按时服药率[91.5%(107/117)]、按时领药率[100.0%(117/117)]、按时复查痰率[83.6%(98/117)]均高于对照组[分别为81.8%(90/110)、92.7%(102/110)、64.5%(71/110)],差异均有统计学意义(x2=4.589、8.820、11.005,P值均<0.05).结论 农村肺结核病防治管理新模式在提高肺结核患者发现率和治愈率,减少患者丢失率,以及改善患者治疗管理状况等方面都有明显效果.
目的 探索有效的農村肺結覈病防治管理新模式,為農村社區肺結覈病防治策略的製定提供科學依據.方法 于總人口為67.9萬人的廣西興業縣,在縣級結覈病防治機構肺結覈診療服務可及性差的農村鄉鎮中,選擇人口數閤計為152 518人的交通不便的4箇鄉鎮作為實驗組,開展以鄉鎮衛生院為診療管理中心、按社區服務可及性設服務點、聘請傢庭督導員協助督導的農村肺結覈病防治管理新模式的項目研究,項目基線及終期肺結覈病例數分彆為44例和117例;同時在該縣選擇條件類似、人口數閤計為133 303人的大平山鎮、龍安鄉和高峰鎮作為對照組.對照組開展現行國傢結覈病防治規劃規定的縣級結覈病診療管理模式,基線及終期肺結覈病例數分彆為56例和110例.採用雙嚮比較方法從肺結覈患者髮現情況、患者治療轉歸情況和結覈病控製工作管理情況等方麵評價新模式的效果.採用SPSS 13.0統計軟件進行統計分析,計數資料的組間比較採用x2檢驗.結果 經過2年的項目實施,項目實施前後實驗組肺結覈患者塗暘新登記率從16.39/10萬(25/152 518)提高到51.14/10萬(78/152 518)(x2=27.281,P<0.01);初治塗暘患者治愈率從71.4%(15/21)提高到91.1%(51/56)(x2=4.812,P<0.05);初治塗陰患者完成療程率從23.5%(4/17)提高到71.4%(15/21)(x2=8.622,P<0.01);初治塗暘患者丟失率從23.8%(5/21)下降為0.0%(0/56)(x2=10.608,P<0.01);初治塗陰患者丟失率從64.7%(11/17)下降為4.8%(1/21)(x2=15.624,P<0.01).項目終期,實驗組的初治塗暘患者治愈率[91.1%(51/56)]高于對照組的治愈率[72.0%(36/50)](x2=6.531,P<0.05),而初治塗暘病例丟失率[0.0%(0/56)]低于對照組[16.0%(8/50)](x2=7.534,P<0.01);項目實施期間實驗組患者的按時服藥率[91.5%(107/117)]、按時領藥率[100.0%(117/117)]、按時複查痰率[83.6%(98/117)]均高于對照組[分彆為81.8%(90/110)、92.7%(102/110)、64.5%(71/110)],差異均有統計學意義(x2=4.589、8.820、11.005,P值均<0.05).結論 農村肺結覈病防治管理新模式在提高肺結覈患者髮現率和治愈率,減少患者丟失率,以及改善患者治療管理狀況等方麵都有明顯效果.
목적 탐색유효적농촌폐결핵병방치관리신모식,위농촌사구폐결핵병방치책략적제정제공과학의거.방법 우총인구위67.9만인적엄서흥업현,재현급결핵병방치궤구폐결핵진료복무가급성차적농촌향진중,선택인구수합계위152 518인적교통불편적4개향진작위실험조,개전이향진위생원위진료관리중심、안사구복무가급성설복무점、빙청가정독도원협조독도적농촌폐결핵병방치관리신모식적항목연구,항목기선급종기폐결핵병례수분별위44례화117례;동시재해현선택조건유사、인구수합계위133 303인적대평산진、룡안향화고봉진작위대조조.대조조개전현행국가결핵병방치규화규정적현급결핵병진료관리모식,기선급종기폐결핵병례수분별위56례화110례.채용쌍향비교방법종폐결핵환자발현정황、환자치료전귀정황화결핵병공제공작관리정황등방면평개신모식적효과.채용SPSS 13.0통계연건진행통계분석,계수자료적조간비교채용x2검험.결과 경과2년적항목실시,항목실시전후실험조폐결핵환자도양신등기솔종16.39/10만(25/152 518)제고도51.14/10만(78/152 518)(x2=27.281,P<0.01);초치도양환자치유솔종71.4%(15/21)제고도91.1%(51/56)(x2=4.812,P<0.05);초치도음환자완성료정솔종23.5%(4/17)제고도71.4%(15/21)(x2=8.622,P<0.01);초치도양환자주실솔종23.8%(5/21)하강위0.0%(0/56)(x2=10.608,P<0.01);초치도음환자주실솔종64.7%(11/17)하강위4.8%(1/21)(x2=15.624,P<0.01).항목종기,실험조적초치도양환자치유솔[91.1%(51/56)]고우대조조적치유솔[72.0%(36/50)](x2=6.531,P<0.05),이초치도양병례주실솔[0.0%(0/56)]저우대조조[16.0%(8/50)](x2=7.534,P<0.01);항목실시기간실험조환자적안시복약솔[91.5%(107/117)]、안시령약솔[100.0%(117/117)]、안시복사담솔[83.6%(98/117)]균고우대조조[분별위81.8%(90/110)、92.7%(102/110)、64.5%(71/110)],차이균유통계학의의(x2=4.589、8.820、11.005,P치균<0.05).결론 농촌폐결핵병방치관리신모식재제고폐결핵환자발현솔화치유솔,감소환자주실솔,이급개선환자치료관리상황등방면도유명현효과.
Objective To explore the effect of new model for tuberculosis (TB) control and management, and provide a scientific basis and justification for making TB control strategies in rural communities. Methods Among those townships with low TB service accessibility by the county TB control institute in Guangxi Xingye county (population of 679 thousands), four townships with total population of 152 518 and inconvenient transportation, were selected as the experimental group to conduct a new model research project. Based on the accessibility for community services, setting diagnosis and treatment management centers in township hospitals, employing family treatment supporters to supervise the treatment process. The TB cases of the base-line and the project expiration of the experimental group were 44 and 117. Meanwhile,three townships including Dapingshan, Longan and Gaofeng in the county with the similar condition and total population of 133 303 were selected as the control group. The control group conducted the provisions of national TB control program in the county TB clinic management. The TB cases of the base-line and the project expiration of the control group were 56 and 110. By double-direction comparison method ,the effect of the new model was evaluated through TB patients detection, treatment outcomes and TB control management data. SPSS 13.0 statistical software was adopted and Chi-square test was used for analyzing technical data. Results After two-year project research implementation, in the experimental group the detection rate of new smear-positive TB patients increased from 16. 39/100 000 (25/152 518) to 51.14/100 000 (78/152 518) (x2 = 27.281, P < 0. 01), the cure rate of new smear-positive cases increased from 71.4% (15/21) to 91.1% (51/56) (x2 = 4. 812, P < 0. 05), and the completing treatment rate in newly diagnosed smear-negative cases improved from 23.5% (4/17) to 71.4% (15/21) (x2 = 8. 622, P <0. 01) ;the loss rate of newly diagnosed smear-positive cases dropped from 23.8% (5/21) to 0. 0% (0/56)(x2 = 10. 608 ,P <0. 01) ,and the loss rate of newly diagnosed smear-negative cases decreased from 64. 7%(11/17)to 4. 8% (1/21) (x2 = 15. 624 ,P <0. 01). Meanwhile ,the cure rate of new smear-positive cases in the experimental group,91. 1% (51/56) ,was higher than the control group,72.0% (36/50) (x2 = 6. 531,P <0. 05). The loss rate of newly diagnosed smear-positive cases in the experimental group(0. 0% (0/56))was lower than the control group (16.0% (8/50)) (x2= 7.534, P< 0.01) . During the project implementation,in the experimental group the on time rate of taking medicine,91.5% (107/117) and receiving medicine, 100. 0% (117/117), the reexamining sputum ratio, 83.6% (98/117) were higher than that in the control group: 81.8% (90/110) ,92. 7% (102/110) and 64. 5% (71/110). The differences were statistically significant (x2 = 4. 589,8. 820 and 11. 005, P < 0. 05). Conclusion The new management model had been proved effective. It can improve TB case detection and cure rates, reduce the loss rate of patients, and improve patient treatment and management conditions as well.
