CAJ | 학술논문

目的探索医院和疾病预防控制机构合作(简称医防合作)防治耐多药结核病的机制,提高耐多药结核病的发现率和治疗水平.方法自2010年3月1日开始,在黑龙江省大庆市、浙江省衢州市、河南省濮阳市、天津市及重庆市万州区建立医防合作防治耐多药结核病机制,开展耐多药结核病的发现和治疗管理工作.收集干预前(2006年1月1日至2009年6月30日)和干预后(2010年3月1日至2012年2月29日)耐多药结核病的发现率、治疗效果及经济负担等方面的资料,并进行对比分析.结果干预后研究地区68.4％(5 287/7 733)涂阳肺结核患者进行了结核病耐药检测,发现的耐多药肺结核病患者数是干预前的9.8倍;纳入耐多药结核病治疗的患者中,93.1％(108/116)使用了规范的初始化疗方案,是干预前的7倍.患者由医院转诊到疾病预防控制机构的到位率由干预前的0％(0/30)提高到干预后的92.8％ (90/97);85.7％(83/97)的患者由疾病预防控制机构落实了治疗管理;6个月注射期结束时,干预后仍在治疗的患者为84.5％ (82/97),痰培养阴转率为56.7％ (55/97);干预后患者自付医疗费用比例、灾难性支出患者比例分别由干预前的75.4％(7 659/1 0158)和76.7％(23/30)下降到18.0％(1 678/9324)和44.7％(17/38).结论建立良好的医防合作机制,能够有效提高耐多药结核病患者的发现率和治疗效果.
목적 탐색의원화질병예방공제궤구합작(간칭의방합작)방치내다약결핵병적궤제,제고내다약결핵병적발현솔화치료수평.방법 자2010년3월1일개시,재흑룡강성대경시、절강성구주시、하남성복양시、천진시급중경시만주구건립의방합작방치내다약결핵병궤제,개전내다약결핵병적발현화치료관리공작.수집간예전(2006년1월1일지2009년6월30일)화간예후(2010년3월1일지2012년2월29일)내다약결핵병적발현솔、치료효과급경제부담등방면적자료,병진행대비분석.결과 간예후연구지구68.4％(5 287/7 733)도양폐결핵환자진행료결핵병내약검측,발현적내다약폐결핵병환자수시간예전적9.8배;납입내다약결핵병치료적환자중,93.1％(108/116)사용료규범적초시화료방안,시간예전적7배.환자유의원전진도질병예방공제궤구적도위솔유간예전적0％(0/30)제고도간예후적92.8％ (90/97);85.7％(83/97)적환자유질병예방공제궤구락실료치료관리;6개월주사기결속시,간예후잉재치료적환자위84.5％ (82/97),담배양음전솔위56.7％ (55/97);간예후환자자부의료비용비례、재난성지출환자비례분별유간예전적75.4％(7 659/1 0158)화76.7％(23/30)하강도18.0％(1 678/9324)화44.7％(17/38).결론 건립량호적의방합작궤제,능구유효제고내다약결핵병환자적발현솔화치료효과.
Objective To improve the effectiveness of case detection and treatment of multi-drug resistant tuberculosis (MDR-TB) by implementing a mechanism of cooperation between hospitals and centers for disease control (CDC).Methods Since 1 March 2010,a new mechanism of cooperation between hospitals and CDCs had been established in 5 cities including Daqing,Quzhou,Puyang,Tianjin and Wanzhou in China.Data of MDR-TB case-detection,treatment and economic burdens before the intervention (January 1,2006-June 30,2009) and after the intervention (March 1,2010-February 29,2012) were collected.Then all data were analyzed by statistical method.Results After the intervention,samples from 68.4％ (5 287/7 733) of smear-positive TB patients in the study regions underwent TB drug-resistant testing,and the number of the detected MDR-TB cases were 9.8 times that prior to the intervention.93.1％ (108/116) of the patients incorporated into the treatment of MDR-TB received the standardized initial chemotherapy program,and the number was 7 times that before the intervention.The referral rates after hospital discharge raised from 0％ before the intervention to 92.8％ after (90/97)the intervention; and 85.7％ (83/97) of the patients received treatment and management by CDC.When the 6-month injection ended,MDR-TB patients still under treatment after the intervention were 84.5％ (82/97),and those whose sputum culture became negative were 56.7％ (55/97).The proportion of patients with self-paid and with catastrophic expenditures after the intervention were reduced to 18.0％ (1 678/9 324) and 44.7％ (17/38) respectively,as compared to 75.4％ (7 659/10 158) and 76.7％ (23/30) respectively before the intervention.Conclusion To establish a well-performed Hospital-CDC cooperation mechanism could promote the performance of MDR-TB case detection and treatment.