本文選題：肺結(jié)核　切入點(diǎn)：鄉(xiāng)村一體化　出處：《山東大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景 目前,我省多數(shù)縣區(qū)正在開展或?qū)嵤┼l(xiāng)村衛(wèi)生一體化改革,將村級(jí)衛(wèi)生室的經(jīng)營管理直接納入鄉(xiāng)鎮(zhèn)衛(wèi)生院管理。通過實(shí)行鄉(xiāng)村一體化管理,合理規(guī)劃和配置鄉(xiāng)村衛(wèi)生資源,規(guī)范服務(wù)行為,提高服務(wù)能力,促進(jìn)新農(nóng)合制度的鞏固和完善,推動(dòng)農(nóng)村醫(yī)療衛(wèi)生事業(yè)健康持續(xù)發(fā)展,滿足廣大農(nóng)村居民的醫(yī)療衛(wèi)生需求。 我國是全球22個(gè)結(jié)核病高負(fù)擔(dān)國家之一,每年新發(fā)肺結(jié)核患者131萬,僅次于印度。結(jié)核病控制工作的核心內(nèi)容是發(fā)現(xiàn)、治愈傳染源。因癥推薦肺結(jié)核可疑者是通過農(nóng)村基層衛(wèi)生組織發(fā)現(xiàn)肺結(jié)核病人的主要方式。鄉(xiāng)村醫(yī)療衛(wèi)生機(jī)構(gòu)是省、市、縣、鄉(xiāng)、村五級(jí)防癆網(wǎng)的網(wǎng)底,在結(jié)核病防治中發(fā)揮著極其關(guān)鍵的作用,擔(dān)負(fù)著肺結(jié)核可疑癥狀者的發(fā)現(xiàn)、推薦或轉(zhuǎn)診以及確診結(jié)核病患者的管理工作。鄉(xiāng)村衛(wèi)生組織一體化管理為增加鄉(xiāng)村醫(yī)生推薦發(fā)現(xiàn)肺結(jié)核患者提供了機(jī)遇。 研究目的 通過分析干預(yù)措施對農(nóng)村肺結(jié)核患者的發(fā)現(xiàn)方式、診斷延誤和治療延誤的影響,評(píng)價(jià)依托鄉(xiāng)村衛(wèi)生組織一體化提高結(jié)核患者發(fā)現(xiàn)策略的效果。研究方法 研究現(xiàn)場分為干預(yù)組縣區(qū)和對照組縣區(qū),在干預(yù)組縣區(qū)實(shí)施一定的干預(yù)措施。收集干預(yù)措施實(shí)施前后兩組縣區(qū)在結(jié)核病防治機(jī)構(gòu)(以下簡稱：結(jié)防機(jī)構(gòu))登記的初治肺結(jié)核患者就醫(yī)模式調(diào)查問卷,從縣區(qū)結(jié)防機(jī)構(gòu)常規(guī)報(bào)表、初診結(jié)核病患者登記本等資料中獲得部分?jǐn)?shù)據(jù)。采用Epidata3.1建立數(shù)據(jù)庫,并錄入數(shù)據(jù),使用SPSS17.0進(jìn)行數(shù)據(jù)分析。在構(gòu)成比的比較分析中采用卡方檢驗(yàn),在患者的就診延誤、治療延誤比較分析中采用秩和檢驗(yàn)。 主要結(jié)果 1、在干預(yù)前,干預(yù)組縣區(qū)結(jié)防機(jī)構(gòu)初診肺結(jié)核可疑者來源以主動(dòng)就診方式為主,干預(yù)后,主動(dòng)就診方式所占比重有大幅度下降,由干預(yù)前的83.2%下降到干預(yù)后的51.1%；村醫(yī)推薦就診方式所占比重有了大幅上升,由干預(yù)前的2.0%上升到干預(yù)后的15.6%。干預(yù)組縣區(qū)結(jié)防機(jī)構(gòu)在干預(yù)前后初診肺結(jié)核可疑者就診結(jié)構(gòu)的差異有統(tǒng)計(jì)學(xué)意義。 2、干預(yù)組縣區(qū)干預(yù)前后結(jié)防機(jī)構(gòu)初診肺結(jié)核可疑者就診癥狀分布不一致�？人钥忍党^3周的可疑者所占的比例有所升高,由干預(yù)前的33.3%上升到干預(yù)后的41.4%；咳嗽咳痰少于3周的可疑者所占的比例有所下降,由干預(yù)前的45.7%下降到干預(yù)后的37.4%。干預(yù)組縣區(qū)結(jié)防機(jī)構(gòu)在干預(yù)前后初診肺結(jié)核可疑者就診癥狀分布的差異有統(tǒng)計(jì)學(xué)意義。 3、干預(yù)組縣區(qū)結(jié)防機(jī)構(gòu)初診肺結(jié)核可疑者中診斷為肺結(jié)核的比例由干預(yù)前的19.5%增加到干預(yù)后的24.0%,排除結(jié)核的比例由干預(yù)前的80.4%下降到干預(yù)后的75.9%。干預(yù)組縣區(qū)實(shí)施干預(yù)措施前后初診肺結(jié)核可疑者診斷結(jié)果構(gòu)成的差異有統(tǒng)計(jì)學(xué)意義。 4、實(shí)施干預(yù)措施后,干預(yù)組縣區(qū)結(jié)防機(jī)構(gòu)活動(dòng)性肺結(jié)核患者發(fā)現(xiàn)數(shù)量較干預(yù)前增長6.1%,而同期對照組縣區(qū)活動(dòng)性肺結(jié)核患者發(fā)現(xiàn)數(shù)量較干預(yù)前減少8.9%。 5、實(shí)施干預(yù)措施后,干預(yù)組縣區(qū)結(jié)防機(jī)構(gòu)的確診肺結(jié)核患者的就診延誤、診斷延誤與治療延誤均比干預(yù)前有所縮短。 結(jié)論與建議 1、干預(yù)措施使得初診肺結(jié)核可疑者就診結(jié)構(gòu)發(fā)生重大改變,村醫(yī)推薦可疑者所占比例較干預(yù)前明顯升高,村醫(yī)推薦在肺結(jié)核患者發(fā)現(xiàn)中的作用得到提升。 2、依托鄉(xiāng)村衛(wèi)生組織一體化采取的干預(yù)措施能夠提高肺結(jié)核患者發(fā)現(xiàn)水平。 3、實(shí)施干預(yù)措施后,干預(yù)縣初診肺結(jié)核可疑者中確診為肺結(jié)核的患者比例明顯升高,排除結(jié)核的比例有所下降。這充分證明干預(yù)措施提高了肺結(jié)核患者發(fā)現(xiàn)的效率,使更多的肺結(jié)核患者得到了及時(shí)的規(guī)范治療,也使得非結(jié)核患者免去了不必要的就醫(yī)環(huán)節(jié),節(jié)約了有限的衛(wèi)生資源。 4、實(shí)施干預(yù)措施后,干預(yù)縣肺結(jié)核患者發(fā)現(xiàn)工作的質(zhì)量明顯提高,肺結(jié)核患者的就診延誤、診斷延誤、治療延誤較之干預(yù)前明顯縮短。這說明基層一體化衛(wèi)生組織發(fā)揮出較好的篩查效果,肺結(jié)核患者得到快速轉(zhuǎn)診和治療,有效地控制了結(jié)核病的傳播,同時(shí)也減輕了非結(jié)核患者的經(jīng)濟(jì)負(fù)擔(dān),避免了醫(yī)療資源的浪費(fèi)。
[Abstract]:Research background
At present, most of the province's counties are carrying out or implementing the rural health integration reform, operation and management of the village health room directly into the township administration. Through the implementation of rural integrated management, rational planning and allocation of rural health resources, service behavior, improve service ability, consolidate and improve the new rural cooperative medical care system, promote the medical and health undertakings rural health and sustainable development, to meet the health demands of rural residents.
China is one of the 22 TB high burden countries, new year 1 million 310 thousand, pulmonary tuberculosis patients after India. The core content of TB control is found, the cure of infection. Because of illness recommended TB suspects through the rural health organization found that the main way of patients with pulmonary tuberculosis. The rural medical and health institutions is the province. City, county, township, the bottom five anti tuberculosis network of the village, plays a key role in TB prevention, charged with TB symptoms found, or recommended referral and management of tuberculosis patients. The integrated management of rural health organizations to increase rural doctors recommend found opportunities for pulmonary tuberculosis patients.
research objective
By analyzing the effect of intervention on the detection mode, diagnosis delay and treatment delay of rural tuberculosis patients, we evaluated the effect of relying on the integration of rural health organizations to improve the detection strategy of TB patients.
The study site is divided into intervention group and control group of counties and county, counties in the intervention group intervention. Intervention measures were implemented in two groups before and after the county in TB prevention and control institutions (hereinafter referred to as: TB) registered pulmonary tuberculosis patient model questionnaire, routine TB institutions report from the county, part of the data the data of newly diagnosed TB patients registered. Epidata3.1 was used to establish database, and input data, using SPSS17.0 for data analysis. The constituent ratio of the comparative analysis using chi square test, delay in treatment of patients with delayed treatment, comparative analysis by rank sum test.
Main results
In 1, before the intervention, the intervention group of county TB institutions in newly diagnosed pulmonary tuberculosis suspects in active treatment mode, intervention, active treatment mode proportion was greatly decreased from 83.2% before intervention after the intervention decreased to 51.1%; the village doctors recommend treatment way of the proportion has increased sharply, rising before the intervention to 2% after the intervention of 15.6%. intervention group counties TB control institutions, there was significant difference in the treatment of newly diagnosed pulmonary tuberculosis suspects structure before and after the intervention.
2, the intervention group before and after intervention in county TB institutions in newly diagnosed pulmonary tuberculosis suspects were inconsistent. Suspicious symptoms distribution of cough and expectoration for over 3 weeks, the proportion increased from 33.3% before intervention, after the intervention increased to 41.4%; less than 3 weeks of suspicious cough sputum accounted for by the decline cases. Decreased from 45.7% before intervention to intervention in the intervention group 37.4%. county TB control institutions, there was significant difference in the newly diagnosed pulmonary tuberculosis suspects symptoms distribution before and after the intervention.
3, the proportion of the intervention group counties TB institutions in newly diagnosed pulmonary tuberculosis suspects in the diagnosis of pulmonary tuberculosis from 19.5% before intervention to 24% after the intervention, the proportion of the exclusion of tuberculosis before intervention decreased to 80.4% after the intervention of 75.9%. intervention group counties before and after the implementation of interventions in newly diagnosed tuberculosis suspicious diagnosis results. The difference was statistically significant.
4, after the implementation of intervention measures, the number of active TB patients in the intervention group was increased by 6.1% compared with that before the intervention. Meanwhile, the number of active TB patients in the control group in the same period decreased by 8.9%. compared with those before the intervention.
5, after intervention, the intervention group of county TB diagnosed patients with pulmonary tuberculosis patient delay, diagnosis delay and treatment delay were shorter than before the intervention.
Conclusions and suggestions
1, intervention measures made significant changes in the structure of the suspected TB patients. The proportion of suspicious persons recommended by the village doctors increased significantly compared with those before the intervention. The role of the village doctors recommendation in the detection of TB patients increased.
2, intervention measures based on the integration of rural health organizations can improve the level of tuberculosis patients.
3, after intervention, intervention with newly diagnosed pulmonary tuberculosis suspects in county tuberculosis patients increased, excluding the decline in the proportion of tuberculosis. It is proved that the intervention measures to improve the efficiency of detection of tuberculosis patients, and has the more standardized treatment of patients with pulmonary tuberculosis, but also makes the non tuberculosis the patients from unnecessary medical links, save the limited health resources.
4, after intervention, intervention in patients with pulmonary tuberculosis in the county found that improved the quality of patients with pulmonary tuberculosis patient delay, diagnosis delay and treatment delay than before the intervention significantly reduced. This shows that the integration of grass-roots health organization play a better effect of screening of patients with pulmonary tuberculosis, rapid referral and treatment, effective control the spread of tuberculosis and non tuberculosis but also reduce the economic burden of the patients, to avoid the waste of medical resources.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R521

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