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地点:泰国南部省份的7家公立医院;目的:评估结核病诊断延误,确定和延误有关的因素,特别关注药店使用和健康保险的覆盖在病人延误中的作用;设计:使用结构式调查问卷,对总共202名新诊断的涂阳和涂阴肺结核病人进行访视调查。结果:病人延误、卫生机构延误及总延误的中位数分别为4.4、2.8和9.4周。病人延误的危险因素为年龄在31-60岁之间、病情较轻、以前有过相似症状及首次接诊不合格等。短时病人延误与健康保险无关。病人有健康保险及第一次在低级别公共卫生机构就诊(如社区医院、健康中心、初级卫生保健点或私人诊所/医院)时,卫生机构延误较长。结论:应当告知公众如何识别结核病症状以缩短病人延误。泰国国家结核病控制规划应该对私人医疗机构包括药店进行督察,以便更好地控制结核病。应当对药店工作人员进行有关可疑结核病人的识别和转诊知识培训。需要提高低级别公共卫生机构和私人医生的结核病诊断能力。应当建立一个合理的转诊系统。
Location: 7 public hospitals in southern Thailand; Purpose: To assess the delay in diagnosis of tuberculosis, to identify and delay related factors, with a particular focus on the role of pharmacy use and coverage of health insurance in patient delays; Design: To use structured questionnaires to assess the total 202 newly diagnosed smear-positive and smear-negative pulmonary tuberculosis patients were interviewed. Results: The median delays for patients, health facilities and total delays were 4.4, 2.8 and 9.4 weeks, respectively. Risk factors for patient delay were between the ages of 31 and 60, with less severe illness, similar symptoms and first-time admissions, and so on. Short-term patient delay has nothing to do with health insurance. Health agencies have long delays when they have health insurance and for the first time at lower-level public health institutions such as community hospitals, health centers, primary health care centers or private clinics / hospitals. Conclusion: The public should be informed about how to identify the symptoms of tuberculosis to shorten the patient’s delay. Thailand’s national tuberculosis control program should supervise private medical institutions, including pharmacies, in order to better control tuberculosis. Knowledge of identification and referral of suspicious TB patients should be trained on pharmacy staff. There is a need to improve the TB diagnosis capacity of lower-level public health agencies and private doctors. A reasonable referral system should be established.