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目的了解新型结核病防治服务体系中结核病定点医院结防工作现状,并分析影响其工作质量的主要因素。方法根据现场调查、每月报表和季度督查结果,对合肥市5家结核病定点医院结核病门诊人员情况、地方财政支持情况、门诊登记/治疗/药品使用/免费政策执行情况等进行统计分析。结果 5家结核病定点医院中有4家门诊医务人员较固定;1家有地方专项经费支持,其余均无;初诊病人登记规范率97.2%、查痰率99.8%,结核病人登记率99.2%,肺结核病人中涂阳检出率30.1%,治疗标准方案使用率77.0%,免费拍摄胸片率70.0%,免费查痰率100%,免费抗结核药品使用率为61.1%。省级医院阳性检出率较高,但免费摄片和免费药品使用较低;县乡级医院在涂阳患者发现、免费摄片和药品使用等方面差异均无统计学意义(P>0.05)。结论定点医院在结防门诊人员的不固定性、医院下达经济指标等问题,当地财政的支持与否是制约该项工作质量的主要因素。
Objective To understand the status quo of TB work in TB hospitals in the new tuberculosis prevention and treatment service system and to analyze the main factors that affect the quality of their work. Methods According to the field survey, monthly report and quarterly survey results, we conducted statistical analysis on the TB clinic staff, local financial support, outpatient registration / treatment / drug use / free policy implementation in 5 TB designated hospitals in Hefei. Results There were 4 outpatient medical staffs in 5 TB designated hospitals, which were more fixed; 1 had local special fund support, and none of them had other specialties; the registration rate of first-time patients was 97.2%, the sputum sampling rate was 99.8%, the TB registration rate was 99.2% The positive rate of smear was 30.1% in patients, 77.0% in standard treatment, 70.0% in free chest radiography, 100% in free sputum and 61.1% in free anti-TB drugs. The positive rate of provincial hospitals was higher, but the use of free videos and free drugs was lower. There was no significant difference in the usage of free photos and drugs between county and township hospitals in smear positive patients (P> 0.05) . Conclusion The fixed-point hospitals in the non-fixed-point clinic staff, the hospital issued economic indicators and other issues, the local financial support or not is the main factor restricting the quality of the work.