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背景:越南胡志明市。目的:描述诊断延误;比较私人和公共卫生保健提供者所采用的诊断程序和转诊常规;检查接触各种不同类型行医者与结核病诊断延误危险性之间的联系。设计:在国家结核病规程中新病人的横断面调查。对以前接触过的卫生保健人员所采用的寻医和诊断程序的回顾性评价。结果:首次症状出现后4周,81%的病人出门看病。首次接触卫生保健机构后4周,有47%诊断为结核病。私人医生比公共卫生保健人员使用X线检查,痰涂片和转诊明显少。首次就到私人药房、私人医生或公立医院就诊的病人比首次就去国家结核病规程部门就诊的病人更有可能发生提供者长时间延误。结论:胡志明市结核病诊断延误更多地是由于卫生保健人员没有能力检出结核病,而不是卫生保健服务未得到充分利用。诊断程序需要完善,转诊工作需要加强,尤其在私人提供者中。
Background: Ho Chi Minh City, Vietnam. Purpose: Describe the delay in diagnosis; compare diagnostic procedures and referral protocols used by private and public health-care providers; and examine the link between exposure to various types of practitioners and the risk of delayed diagnosis of tuberculosis. Design: Cross-sectional survey of new patients in national tuberculosis procedures. Retrospective evaluation of medical and diagnostic procedures used by previously exposed health care workers. Results: Four weeks after the first symptoms, 81% of the patients went to see a doctor. Four weeks after first contact with health care facilities, 47% were diagnosed with tuberculosis. Private doctors use X-rays more often than public health workers, with significantly fewer sputum smears and referrals. For the first time, patients visiting private pharmacies, private doctors or public hospitals are more likely to have protracted delays on providers than patients who have been on a national TB program for the first time. Conclusion: The delay in diagnosing tuberculosis in Ho Chi Minh City is more due to the inability of health-care workers to detect tuberculosis, rather than the underutilization of health-care services. Diagnostic procedures need to be refined and referrals need to be strengthened, especially among private providers.