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目的探讨四川省藏区非结核病防治机构医生对结核疑似病人确诊延迟的影响。方法通过问卷收集初次到若尔盖和石渠县结防机构诊治的结核疑似病人的资料,调查首诊为非结防机构医生的结核疑似病人确诊延迟情况。结果80.0%结核疑似病人首诊选择非结防机构医生,且其中最后被结防机构确诊为活动性肺结核的42例患者中,54.8%发生了确诊延迟;不同类非结防机构医生在各自接诊的病人中,藏医首诊结果怀疑结核病的比例低于个体医生、乡村医生与县级医生等(P<0.001);首诊选择藏医的结核疑似病人确诊延迟发生率高于选择乡村医生和县级医生等的(P=0.008);未被非结防医生推荐到结防机构就诊者较被推荐者确诊延迟发生率高(P<0.001)。结论非结防机构医生的类型、首诊结果及其是否推荐结核疑似病人到结防机构就诊与结核疑似病人的确诊延迟有关;培训非结防机构医生的结核病知识、加强归口管理可减少结核疑似病人的确诊延迟。
Objective To explore the influence of non-tuberculosis prevention and treatment institutions doctors in Sichuan’s Tibetan areas on the delayed diagnosis of suspected tuberculosis patients. Methods The questionnaire was used to collect the data of suspected tuberculosis patients who were initially diagnosed and treated in the Ruoergai and Shiqu County Narcotics Prevention and Control Institutions. Results Of the 80.0% of the suspected tuberculosis patients, 54.8% of the 42 patients who were non-TB patients were diagnosed as active tuberculosis and were diagnosed as active tuberculosis at the first diagnosis. Delayed diagnosis was found in 54.8% Among the patients who were diagnosed, the proportion of TB patients suspected of TB was lower than that of individual physicians, village doctors and county doctors (P <0.001) (P = 0.008). Patients who had not been recommended by non-stop doctor to boarders had a higher incidence of delayed diagnosis than those recommended (P <0.001). Conclusions The types of doctors in non-prevention institutions, the results of the first diagnosis and whether they recommend referrals to the TB institutions for TB suspects are related to the delayed diagnosis of suspected tuberculosis patients. Training tuberculosis knowledge of non-TB doctors and strengthening centralized management can reduce the suspicion of tuberculosis The patient’s diagnosis is delayed.