| Pulmonary tuberculosis (TB) is a lung chronic infectious disease caused by Mycobacterium tuberculosis, which is a leading cause of death of the major infectious diseases in adults all over the world. China is one of the TB high-burden countries in world. TB is one of the key controlling infectious diseases in China.Studies have shown that TB specialist hospitals are major medical institutions that patients prefer to seek treatment. However, patients from the specialty hospitals were not included in the TB planning and management in the past, so the Shenyang TB statistics were not a total representative of the city as a whole. Therefore, whether TB patients'management of specialist hospitals is effective and the specialist hospitals and TB prevention and controlling agency is in Full co-operation, it will directly affect the implementation of tuberculosis control program. In practice, it is found that the low rate of referral medical institutions, the serious shortage of professionals in TB prevention and controlling agency to track patients all affect the patients found. Therefore, it is need to change the management of tuberculosis patients in special hospitals, strengthen referral and the whole management, in particular to explore a new suitable TB specialist hospitals and TB prevention and control agency cooperation mode to play advantages of both hospitals and TB prevention and control agency. It will have a very important practical significance in the implementation of tuberculosis control program.Cooperation mode between comprehensive medical institutions and the TB prevention and controlling institutions has been undertaken a few years, but the research of the management mode and cooperation mode in tuberculosis specialist hospital is in its beginning. However, patients from comprehensive medical institutions are all suspected patients and which in Shenyang Chest Hospital are all confirmed, it is very important to explore a suitable TB specialist hospitals and TB prevention and controlling agency cooperation mode. Objectives:This study analyzes all the confirmed TB inpatients data reported by Shenyang Chest Hospital from April, 2006 to March, 2008. The purpose is to learn the TB prevention and control status in Shenyang Chest Hospital, explore main problems and countermeasures existed in the management of TB patients and find out a suitable TB specialist hospitals and TB prevention and control agency cooperation model which will improve the detection rate and cure rate ,reduce drug-resistant patients, manage the source of infection and provide a scientific basis for establishing a medical anti-cooperative mechanism and achieving patient full management.Methods:1. Analyze and describe all the confirmed TB inpatients data combining with the results of laboratory examination and chest X-ray data reported by Shenyang Chest Hospital from April, 2006 to March, 2009.Evaluate the effectiveness of the management model before and after the implementing interventions and summarize a new TB management model in TB specialist hospital that fit to the actual situation in Shenyang.2. Use Epidata for data entry and collation, use SPSS13.0 for statistical analysis. The main method of statistical analysis is Chi-square test.Results:1. The report numbers of inpatients on network are 588, 927 and 2208cases in Shenyang Chest Hospital from April, 2006 to March, 2009. Patients are mainly concentrated in the 40-64 years group, male to female ratio is about 2:1, the Han nationality is the most, occupational distribution is mainly mostly domestic helpers and unemployed, workers, retired staff ,cadres and staff.2. In reported cases of three years, the proportion of smear-positive cases is 70.1%, 42.2% and 26.9%. Positive rate of sputum, the proportion of first treatment in smear-positive cases the detection rate of patients with abnormal chest X-ray increased annual, but the detection rate of smear positive patients decreased year by year. The difference was statistically significant (P<0.05).3. After the implementation of the new management mode and interventions, the pulmonary tuberculosis reporting rate increased from 70.7% to 100.0%, systems management rates increased from 3.4% to 83.0%. The completion of treatment rates and the cure rate are both increased, the differences are significant (P<0.05). 4. Analyzed the all management cases, the hospital management accounted for 39.0%, the management of TB prevention and controlling agency accounted for 44.0%. Reasons for other cases not taken in system management are followed by unknown or incorrect information, the patient refused treatment, and patients go away from Shenyang and death.Conclusions:Effective cooperation mechanisms and management mode Tuberculosis specialist hospitals and TB control organizations to establish can effectively increase the reporting rate, referral rate, system management rate, the completion of treatment rate and cure rate and other indicators, which is a effective mode in tuberculosis prevention, controlling and management. There is a more effective management mode that is to integrate Tuberculosis specialist hospitals into public health management system, which can enhance the whole TB management further. |
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