The Study Of Community Health Service Institutions In The Tuberculosis Control System

ObjectivesAt present, the management and supervision of most tuberculosis patients are carried out in the community in China. This study aims to evaluate the role of community health service institutions in the tuberculosis control system, analyze its effect in the management and supervision of tuberculosis patients, to provide reference for the formulation of TB control program and policy.MethodsThe literatures of multiple databases and the websites of some health institutions were searched to make a systematic review of the development of treatment and management strategy of tuberculosis. The implementation of DOTS strategy in China was evaluated in two aspects:the supervision and treatment adherence and the effects of treatment and management strategy of tuberculosis were analyzed. The policies, statements and reports of tuberculosis control in Wuhan city were collected to conduct an effective analysis. The leadership and management personnel of health department and tuberculosis dispensary of Wuhan city were interviewed. All the community health centers (n=102) and the tuberculosis control personnel (n=110) in the central districts of Wuhan city were investigated。All the tuberculosis patients (n=134) in Jianghan and Qiaokou district were investigated with self-made questionnaire. Epidata 3.02 was employed for inputting data and SPSS 15.0 were used for data analysis.ResultsThe meta-analysis of 12 studies of the supervision and dose missing of tuberculosis patients showed that more than half of patients (51.2%) were self-administration, the proportion of the family supervision (26.8%) was higher the health personnel supervision (20.4%).26.9% of the patients had ever missed their doses, missing doses happened much more frequently in urban patients (41%) than in rural ones (14%).The meta-analysis of 12 intervention studies have found that early in 1993 there was the management model of tuberculosis patients that tuberculosis specialists provided training and technical guidance, and community health personnel carried out follow up and conduct observation with family members. Nowadays it still was the dominant model of TB cases management in China. Since 2000 the community health service institutions have participated in and this model have been developed. The main supervisors were family members (38/50) and community health personnel (20/50), the tuberculosis specialists were mainly responsible for personnel training, health education and technical guidance.The analysis of treatment and management strategy of tuberculosis in Wuhan city showed that the investment of tuberculosis control was increasing year by year, there were certain results in treatment cost reduction of tuberculosis patients and medical aid for special population. But there were still some problems such as low proportion of basic medical insurance claims of the outpatient cost, limited payment contents of treatment cost reduction policy, and insufficient incentives for elementary health care workers.The analysis of treatment and management strategy of tuberculosis in Wuhan city showed that the investment of tuberculosis control was increasing year by year, there were certain results in treatment cost reduction of tuberculosis patients and medical aid for special population. But there were still some problems such as low proportion of basic medical insurance claims of the outpatient cost, limited payment contents of treatment cost reduction policy, and insufficient incentives for elementary health care workers.The field investigation of 102 community health centers and 110 community tuberculosis control personnel showed that all the community health centers of Wuhan city had some community tuberculosis control personnel and the related training programs were carried out. 92.16% of the community health centers were equipped with X-ray machine,96.04% of the community health centers had set up tuberculosis treatment rooms equipped with related equipment, more than 90% of community health centers conducted tuberculosis patients registration of outpatient, referral and follow-up registration. In 2009 the average management cases of the investigated centers were 21.21, and the average proportion by medical personnel supervision of the proportion of the average of 68.02%.The questionnaire survey of 134 community tuberculosis patients showed that half of them could get to the medical institution providing tuberculosis treatment by walking in 10 minutes. The first treatment institution of most patients (89.6%) was tuberculosis dispensary and y8.4% of the patients could receive diagnosis and treatment in time. Most patients (92.5%) were covered by health insurance. Most patients agreed that the reimbursement of tuberculosis treatment costs was timely and effective. Most tuberculosis costs were concentrated before the tuberculosis was diagnosed, the cost reduction of anti-tuberculosis drugs, liver protection drugs, physical examination and medical aid had obtained certain results.Conclusions1. The proportion of patients who took doses under supervision was low, the regular treatment needed to be improved.2. The community health service institutions were very important in the tuberculosis control system of China.3. The community health service institutions can meet the basic requirements of providing tuberculosis control services,4. The community health personnel were easier to access the trust of patients and have some advantages in the tuberculosis cases management.5. The management of tuberculosis patients in community improved the accessibility of medical service and controlled the treatment costs.Policy Suggestions1. Community health service institutions should be paid enough attention in tuberculosis control and tuberculosis patient management and get policy support.2. The tuberculosis control training model of community health personnel should be developed to improve the staff quality. The allocation standards of tuberculosis control personnel and equipment should be established.3. The administrative regulations of the basic medical insurance for urban workers/residents for tuberculosis patients should be established. The reimbursement policy should consider the basic medical insurance for urban residents. The cost reeducation for the low income tuberculosis patients should be increased.InnovationThis study has evaluated the important effect of community health service institutions in tuberculosis control from the aspects of policy, institution, personnel and tuberculosis patients for the first time. The variables are multiple and the data are detailed, so this study has a certain degree of depth and scope. The study firstly discusses the compensation mechanism of tuberculosis treatment cost and its effect, and can provide some references for policy making and practice.LimitationThe investigation of tuberculosis patients was only located in Jianghan and Qiaokou district of Wuhan city because of the limitation of time and research funding. The sample size was small, and the representativeness of the study and generalization of the conclusions were limited. To sample the tuberculosis patients of different cities with varied economic development levels in the eastern, central and western provinces of China is the focus of future study to improve study quality.