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目的探讨综合性医疗机构对肺结构病诊断延误的影响,为提高病人发现率提供参考。方法采用前瞻性队列研究与定性方法相结合,对在重庆市2个区选定的综合医疗机构就诊的结核疑似病人进行为期3个月的随访调查,并对医务人员和相关政策决策者进行个人深入访谈,以了解病人的就诊经历,分析卫生服务供方因素对结核病诊断的影响。结果49.2%的病人选择区级医院作为他们初次就诊单位;61.0%的病人被建议接受X光检查,19.1%的病人被建议进行痰检,仅4.9%的病人被建议转至结防所。定性研究支持定量的发现,医务人员对结核病控制策略了解甚少。结论综合医疗机构在结防控制工作中没有发挥应有的作用,结核控制策略在综合医疗单位中宣传不够,并缺乏与结防体系间的有效交流和合作。
Objective To investigate the impact of comprehensive medical institutions on the diagnosis of pulmonary structural diseases and provide reference for improving the detection rate of patients. Methods A prospective cohort study combined with qualitative methods was used to conduct a 3-month follow-up survey of suspected tuberculosis patients in selected general medical institutions in 2 districts in Chongqing. Individuals of medical personnel and relevant policy makers In-depth interviews to understand the patient’s medical experience, analysis of health care providers factors on the diagnosis of tuberculosis. Results 49.2% of the patients chose district hospitals as their first visit; 61.0% of the patients were recommended for X-ray examination, 19.1% of patients were recommended for sputum examination, and only 4.9% of patients were advised to go to the XFX. Qualitative research supports quantitative findings, and medical staff have little knowledge of tuberculosis control strategies. Conclusion The integrated medical institutions did not play a proper role in the prevention and control of tuberculosis. The tuberculosis control strategies were not sufficiently publicized in the general medical units and lacked effective communication and cooperation with the prevention and control system.