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目的研究杭州市耐多药结核病的危险因素。方法通过利益相关者深度访谈、二手资料收集以及案例分析收集所需信息,通过分级编码和Mindmanager 9.1.157进行分析和各因素与耐多药结核病因果关系图的构建。结果一级编码因素有:患者服药不规则和治疗方案不正确。二级编码包括药品不良反应、忘记吃药、疗程中断、心理因素、治疗方案不规范、检测信息迟滞等。三级编码因素有药品质量剂量剂型、医生技能、患者和家庭成员缺乏相关知识、督导员工作未尽职、经济困难、看病不便等数十项。部分三级编码因素还分解到四级和五级编码。编码的层级只反映各因素在因果关系图中的位置,并不代表重要程度。结论造成杭州市耐多药结核病的因素包括社会福利制度、社会歧视、工资改革、医疗体制改革、医疗和检测技术缺陷、药品质量和剂型问题等诸多方面,因此控制耐多药结核病也需要多方面共同努力。
Objective To study the risk factors of multidrug-resistant tuberculosis in Hangzhou. Methods To collect the required information through stakeholder in-depth interviews, secondary data collection and case analysis, analysis by hierarchical coding and Mindmanager 9.1.157, and construction of a causal relationship map between the factors and MDR-TB. Results of a coding factor are: irregular medication and treatment of patients is not correct. Two levels of coding, including adverse drug reactions, forget to take medicine, treatment interruption, psychological factors, treatment programs are not standardized, such as detection of information delay. Three levels of coding factors include drug quality dosage forms, doctor skills, lack of relevant knowledge of patients and family members, supervisors’ lack of due diligence, financial difficulties and inconvenience of attending medical treatment. Some three-level coding factor is also decomposed into four levels and five levels of coding. The level of coding only reflects the location of each factor in the causal map does not represent the degree of importance. Conclusion The factors causing MDR-TB in Hangzhou include many aspects such as social welfare system, social discrimination, wage reform, medical system reform, medical and testing technical defects, drug quality and dosage forms, etc. Therefore, multi-drug resistant tuberculosis needs to be controlled in many aspects Work together.