广西医学
廣西醫學
엄서의학
Guangxi Medical Journal
2015年
7期
948-952
,共5页
林定文%林玫%崔哲哲%曹子中%吴腾燕%刘明团%区进
林定文%林玫%崔哲哲%曹子中%吳騰燕%劉明糰%區進
림정문%림매%최철철%조자중%오등연%류명단%구진
结核病%定点医院%效能%河池市%转型
結覈病%定點醫院%效能%河池市%轉型
결핵병%정점의원%효능%하지시%전형
Tuberculosis%Designated hospital%Efficiency%Hechi%Transformation
目的:了解广西河池市6县(区)结核病定点医院转型初期服务现状,评估其服务效能。方法采取现场调查和患者访谈的方式,分别对由疾控模式转型为定点医院模式的天峨县、凤山县、罗城县、环江县、都安县、金城江区6县(区)人民医院可疑肺结核患者就诊及活动性肺结核患者登记、结核病防控(结防)人员数量、绩效工资水平、结防经费投入、门诊和住院诊疗规范程度、实验室痰检质量、患者管理、医疗费用负担等进行核实评估。结果2013年(转型后)天峨县、罗城县结核病初诊患者数较2011年(转型前)下降;转型后金城江区、凤山县、罗城县活动性肺结核患者登记数较转型前下降,其他县均有上升。转型后各院结防人员平均3.50名,结防经费中位数为3.34万元;病案检查结果显示:痰培养、结核分枝杆菌耐药性检查、听力、视力及育龄妇女尿妊娠试验检查例数均为0;痰涂片阳性率5.10%(156/3060),各实验室阳性符合率平均为83.33%(25/30);门诊、住院化疗方案执行率分别为93.33%(84/90)和71.67%(43/60);13.33%(8/60)抗结核药用药不合理;治愈率77.78%(70/90);47.62%患者认为治疗费用不重,42.86%患者认为治疗费用重但可承受,9.52%患者认为治疗费用重不可承受。结论整体上转型初期定点医院模式仍未能体现结核病诊疗管理的优势,各地转型工作准备不充分,各院因人员、经费、制度、技术等客观条件制约,结核病服务能力有待加强。
目的:瞭解廣西河池市6縣(區)結覈病定點醫院轉型初期服務現狀,評估其服務效能。方法採取現場調查和患者訪談的方式,分彆對由疾控模式轉型為定點醫院模式的天峨縣、鳳山縣、囉城縣、環江縣、都安縣、金城江區6縣(區)人民醫院可疑肺結覈患者就診及活動性肺結覈患者登記、結覈病防控(結防)人員數量、績效工資水平、結防經費投入、門診和住院診療規範程度、實驗室痰檢質量、患者管理、醫療費用負擔等進行覈實評估。結果2013年(轉型後)天峨縣、囉城縣結覈病初診患者數較2011年(轉型前)下降;轉型後金城江區、鳳山縣、囉城縣活動性肺結覈患者登記數較轉型前下降,其他縣均有上升。轉型後各院結防人員平均3.50名,結防經費中位數為3.34萬元;病案檢查結果顯示:痰培養、結覈分枝桿菌耐藥性檢查、聽力、視力及育齡婦女尿妊娠試驗檢查例數均為0;痰塗片暘性率5.10%(156/3060),各實驗室暘性符閤率平均為83.33%(25/30);門診、住院化療方案執行率分彆為93.33%(84/90)和71.67%(43/60);13.33%(8/60)抗結覈藥用藥不閤理;治愈率77.78%(70/90);47.62%患者認為治療費用不重,42.86%患者認為治療費用重但可承受,9.52%患者認為治療費用重不可承受。結論整體上轉型初期定點醫院模式仍未能體現結覈病診療管理的優勢,各地轉型工作準備不充分,各院因人員、經費、製度、技術等客觀條件製約,結覈病服務能力有待加彊。
목적:료해엄서하지시6현(구)결핵병정점의원전형초기복무현상,평고기복무효능。방법채취현장조사화환자방담적방식,분별대유질공모식전형위정점의원모식적천아현、봉산현、라성현、배강현、도안현、금성강구6현(구)인민의원가의폐결핵환자취진급활동성폐결핵환자등기、결핵병방공(결방)인원수량、적효공자수평、결방경비투입、문진화주원진료규범정도、실험실담검질량、환자관리、의료비용부담등진행핵실평고。결과2013년(전형후)천아현、라성현결핵병초진환자수교2011년(전형전)하강;전형후금성강구、봉산현、라성현활동성폐결핵환자등기수교전형전하강,기타현균유상승。전형후각원결방인원평균3.50명,결방경비중위수위3.34만원;병안검사결과현시:담배양、결핵분지간균내약성검사、은력、시력급육령부녀뇨임신시험검사례수균위0;담도편양성솔5.10%(156/3060),각실험실양성부합솔평균위83.33%(25/30);문진、주원화료방안집행솔분별위93.33%(84/90)화71.67%(43/60);13.33%(8/60)항결핵약용약불합리;치유솔77.78%(70/90);47.62%환자인위치료비용불중,42.86%환자인위치료비용중단가승수,9.52%환자인위치료비용중불가승수。결론정체상전형초기정점의원모식잉미능체현결핵병진료관리적우세,각지전형공작준비불충분,각원인인원、경비、제도、기술등객관조건제약,결핵병복무능력유대가강。
Objective To explore the current health service status of tuberculosis(TB) designated hospitals in early transformation stage from six counties/districts in Hechi,Guangxi,and to evaluate their service efficiency.Methods By the means of field investigation and patient interview,we evaluated the suspected TB patients′visiting doctor data,active TB patients′registration data,number and performance-related pay of TB prevention and control staff,funds for TB prevention and control,inpatient and outpatient diagnosis and treatment standardization,quality control of sputum examination in laboratory,management of TB patients,and medical costs in the people′s hospitals,which were TB designated hospital transformed from the hospital of disease prevention and control,from Tiane County,Fengshan County,Luocheng County,Huanjiang County, Duan County and Jinchengjiang Ditrict.Results The number of initial TB patients decreased in 2013( after transformation) in contrast with the data in 2011 ( before transformation) in Tiane County and Luocheng County.The number of active TB patients decreased after transformation in Jinchengjiang District, Fengshan County and Luocheng County in contrast with the data before transformation, which increased in the other counties after transformation.The average of TB prevention and control staff was 3.50 while the median of the funds for TB prevention and control was 33.4 thousand yuan.The result of medical record check showed that no cases accepted the examinations of sputum culture,drug-resistant test of Mycobacterium tuberculosis,hearing test and visual acuity test,and no childbearing women accepted Konsuloffˊs test.The positive rate of sputum smears was 5.10%(156/3 060).The average positive coincidence rate of laboratory examinations was 83.33%(25/30).The rates of chemotherapy treatment were 93.33%(84/90,outpatient) and 71.67%(43/60,inpatient),respectively. 13.33%(8/60) of anti-tuberculosis medication was unreasonable.The cure rate was 77.78%(70/90).47.62%of the patients thought their treatment costs were not expensive,42.86%of the patients thought their treatment costs were expensive and sustainable,and 9.52%of the patients thought their treatment costs were unsustainable.Conclusion The pattern of TB designated hospital does not embody the advantage of TB diagnosis,treatment and management overall.For the hospital transformation in each county/district is poor-prepared and the objective conditions,such as staff,funds,rules,technologies and so on,are limited in each hospital,we should strengthen the ability to provide the service for TB patients.