Objective To analyse the treatment situation, practical needs and the primary medical institutions participation of newly registered migrating population tuberculosis patients in Panyu District in 2018, to propose measures to improve the equalization of basic public health services for tuberculosis discovery among migrating population in Panyu District.
Methods Design the survey form according to the research purpose and content of the fund project. For the newly registered migrating population tuberculosis patients in 2018, convenient sampling survey was conducted on the status and needs of the patients during the re–visit; the service contents of patients were surveyed in 10 enterprises with large numbers of migrating population patients and all community health service centers in 2018. After information perfection and logical check, the information table was converted into FoxPro 6.0 database for statistics, to analyse the condition of delay and its reasons, demand intention of the patients, the patient’s first treatment unit and referral situation, and the enterprise and community implementation of the patient’s discovery service content.
Results Totally 60 cases were delayed in 210 newly registered patients in 2018, delay rate 28.57%. Doctors delayed were 82 cases, delay rate 39.05%. 60 patients delayed was mainly caused by self–belief that their symptoms were not serious and they did not need to see a doctor. The main reason for the 82 cases of doctor delay was two weeks of anti–inflammatory. District level general hospital was the main unit for the first visit of 210 newly registered patients. In the first diagnosis unit, the referral rate was higher for physical examination institutions, municipal general hospitals. Among the 210 newly registered patients in requirement discovery intention, 113 patients had no appeal, accounting for 53.81%. In the 10 enterprises with the largest number of patients, 60% of them set up health clinics and have people in charge; 70% of workshops are equipped with health monitoring personnel; 50% of enterprises participate in annual X–ray physical examination; symptom screening was carried out in 80% of the clinics. Among the 16 community health service centers, 56.25% provide more than one publicity service to enterprises every year; 12.50% provide free chest X–ray screening for patients with suspected tuberculosis symptoms recommended by enterprises; 93.75% carry out active tracking work to those suspected of tuberculosis.
Conclusion The migrating population tuberculosis patients in our district are still characterized by high rate of delay in treatment and diagnosis, inconvenient medical environment in prevention institutions, low referral rate in primary medical institutions, and insufficient work participation in community health service centers and enterprise patients. Therefore, the government should increase investment to continuously improve the diagnosis and treatment environment of the regional knot prevention institutions; improve the X–ray examination ability of health community health service center; gradually extending the basic public health service items to factories and enterprises is the direction of our district to achieve equal discovery services for migrating population tuberculosis patients.
摘要： 目的 对2018年广州市番禺区新登记流动人口肺结核患者就诊情况、现实需求和基层医疗机构参与患者发现情况进行分析, 提出完善番禺区流动人口结核病发现基本公共卫生服务均等化的措施。 方法 按照基金课题项目研究的目的和内容自行设计调查表格。对2018年新登记的流动人口肺结核患者, 在复诊时对患者发现状况及需求进行便利抽样调查; 对辖区2018年流动人口患者较多的10家企业和全部社区卫生服务中心进行患者发现服务内容调查。调查内容经过信息完善和逻辑核对后, 将信息表转换成FoxPro 6.0数据库进行统计, 分析患者就发现延误状况及其原因和需求意向、患者首次就诊单位及转诊情况、企业和社区落实患者发现服务内容情况。 结果 2018年210例新登记患者本人就诊延误60例, 延误率为28.57%; 医生延误人数为82例, 延误率为39.05%。60例患者延误原因主要是自我认为症状不严重且不需要就诊; 82例医生延误的原因主要是先消炎2周。210例新登记患者首次就诊单位主要是区级综合医院;在首诊单位中, 转诊率较高为体检机构、市级综合医院。在210例新登记患者发现需求意向中, 患者无诉求113例, 占53.81%。在患者最多的10家企业中, 60%有设置卫生室且有专人负责; 70%车间设健康监测人员; 50% 企业参加年度X线体检; 80%卫生室有开展症状筛查。16家社区卫生服务中心中, 56.25%每年对企业提供1次以上宣传服务; 12.50%对企业推荐来的肺结核可疑症状者提供免费胸片筛查; 93.75%对肺结核可疑者开展主动追踪工作。 结论 番禺区流动人口肺结核患者仍存在就诊及确诊延误率高、结防机构就医环境不便、基层医疗机构转诊率低、社区卫生服务中心和企业患者发现工作参与度不够等特点, 政府应加大投入, 改善区结防机构诊治环境; 提高卫生社区卫生服务中心X线检查能力; 逐步将基本公共卫生服务项目内容向工厂、企业延伸等, 是广州市番禺区实现流动人口肺结核患者发现服务均等化的努力方向。