Study On The Application Effect Of Tuberculosis Control Mode In Guangxi

Section one：Evaluate on the implementation effect of current tuberculosiscontrol mode in GuangxiObjective To investigate the implementation situation of tuberculosis（TB）prevention and control work，and evaluate the implementation effects andapplication prospect of TB control mode，in order to provide the scientificreference for establishing the most suitable TB control mode in Guangxi.Methods The four different TB control mode areas were selected by using thepurposive sampling method，the data of the implementation situation of TBcontrol work were collected by investigating the relevant organizations，keyfigures interviews，questionnaire survey，refering to the TB reported system andso on，and to carry out data analysis and comprehensive evaluation. Results（1）The mainly TB prevention and control mode in Guangxi was the Center forDisease Control and Prevention （CDC） mode，besides，there were the TBdesignated hospital mode，the TB hospital mode and the independent TBdispensary mode（.2）The results of analyzing the institution building situationwere as follows：①There were work places in the four TB control mode areas，but the numbers of personnel in TB control institutions were not fulfill the requirement of the TB guidelines；②The chest radiographic inspectionequipment in the CDC mode area was the ordinary X-ray machine of200mA，but there was the Digital Radiography machine（DR） in other three TB controlmode areas；③The sputum smear microscopy was carried out in all the TBcontrol mode areas, there were the mycobacterium culture and the anti-TBmedicine sensitivity test in the TB designated hospital mode areas.（3）Theresults of analyzing the registration and treatment situation of pulmonary TB（PTB）patients in the four TB control mode areas were as follows：①Therewas statistically significant difference in the constituent ratio of PTB patients ofnew smear-positive, retreatment smear-positive and smear-negative（χ2=82.791，P=0.000），there were the highest percentage of new smear-positivepatients（52.4%，269/513）in the TB designated hospital mode areas；②Therewas statistically significant difference in the constituent ratio of the source ofPTB patient（sχ2=183.774，P=0.000），there were the highest percentage of PTBpatients from clinic visit due to symptoms in the independent TB dispensarymode area（s46.9%，201/429），there were the highest percentage of PTB patientsfrom referral in the TB designated hospital mode areas（67.8%，348/513）；③There was statistically significant difference in the rate of sputum smearmicroscopy in first visit patient（sχ2=622.461，P=0.000），there were the highestrate in TB designated hospital mode areas（86.3%，1404/1627）；④There wasstatistically significant difference in the total arrival rate of PTB patientsreported by non-TB control institutions（χ2=20.162，P=0.000），there were thehighest total arrival rate in the TB hospital mode areas（99.7%，583/585）；⑤There was statistically significant difference in the cured rate of newsmear-positive PTB patients（χ2=11.586，P=0.009），there were the highestcured rate in the independent TB dispensary mode areas（96.2%,177/184）；⑥ There was statistically significant difference in the timeliness rate of theinformation input when the PTB patients completed treatment（χ2=556.218，P=0.000），there were the highest timeliness rate in the TB designated hospitalmode areas（74.3%，381/513）；⑦There was statistically significant differencein the consistent rate of the information input，there were the highest consistentrate in the CDC mode areas（55.0%，22/40）.（4）The results of analyzing thecompletion rate of the supervision task of TB control in the four TB controlmode areas were as follows：①There was statistically significant difference inthe completion rate of the supervision task at county level（χ2=79.037，P=0.000），there were the highest completion rate in the TB designated hospitalmode areas（138.7%，233/168）；②There was statistically significant differencein the completion rate of the supervision task of visiting the PTB patients（χ2=2612.537， P=0.000）， there were the highest completion rate in the TBdesignated hospital mode area（s147.7%，1192/807）（.5）The result of analyzingthe patients delay in the four TB control mode areas showed there wasstatistically significant difference in the number of days of patients delay（H=121.158，P=0.000），there were the shortest days of patients delay in theTB designated hospital mode areas（the median are17days）.（6）The result ofanalyzing the panel testing in the four TB control mode areas showed neitherarea appeared false positives and false negatives.（7）The result of analyzing thejob satisfaction of85workers in the four TB control mode areas showed therewere statistically significant difference in the overall workers satisfaction andthe workers satisfaction on working equipments，（the value of χ2were18.348and9.730respectively，the value of P were0.000and0.021respectively.）,therewere the highest overall workers satisfaction （44.7%，38/85）and the highestworkers satisfaction on working equipments （64.7%，11/17）in the TB designated hospital mode areas.（8）The result of analyzing the patientssatisfaction of102PTB patients completed treatment in the four TB controlmode areas showed there were statistically significant difference in the patientssatisfaction on the total treatment costs（χ2=10.228，P=0.017），there were thehighest satisfaction in the independent TB dispensary mode areas（71.4%，15/21）.（9）The result of the TOPSIS comprehensive evaluation showed thecomprehensive efficiency of TB control in the TB designated hospital modeareas ranked first （C1=0.692）.（10）It needed to pay for the lowest directmedical costs when the PTB patient received treatment in the TB outpatient ofthe TB designated hospital mode areas（￥2336.3per one）.Conclusions （1）The four TB control mode played an important role in the PTB patientsdiscovery，reporting，treatment and management，basing on the medicalcooperation mechanism and the“eight modules”theory in Guangxi. But therewere still needed to strengthen the construction of human resource，for ensuringthe quality and efficiency of TB control work.（2）There was lower workerssatisfaction，it should pay more attention on the workers workload and theworking conditions（.3）The patients satisfaction needed to be improved，and theproblem of reducing the patients economic burden needed to be solved.（4）Theadvantages in the TB designated hospital mode areas were as follows，theequipments of diagnosis and treatment was advanced， the division ofresponsibilities was clearly, the information communication mechanism wassmooth，the supervision system was more perfectly，the direct medical costs thatthe PTB patients needed to pay were the lowest. Therefore, the TB designatedhospital mode had a good application prospect under the condition of effectiveimplementation of the TB appropriation reimbursement and the supportingmeasures in Guangxi. Section two： Study on the establishment situation of the “trinity”tuberculosis control modeObjective To investigate the establishment situation of the “trinity” TBprevention and control service system，and provided reasonable suggestions forthe possible problems， in order to provide the scientific reference forestablishing this TB prevention and control service system in Guangxi. MethodsOne key figure in the health administration departments and the TB controlinstitutes of14cities and27counties was selected respectively usingconvenience sampling method， the acceptability survey on the “trinity” TBcontrol mode was carried out，and to analyze the feasibility of establishing thisservice system in Guangxi. The16counties started to establish the “trinity” TBcontrol mode in the year2012were selected using purpose sampling method，the data of the establishment process of this TB control mode and the relevantmedical security mechanism were collected by key figures interviews，questionnaire survey，refering to relevant data，and so on，and to carry out dataanalysis. Results （1）Most of the interviewees accepted the “trinity” TBcontrol mode， the acceptability proportion among the leaders of healthadministration departments，leaders in charge of TB control institutions，anddirectors of TB control institutions were73.7%（28/38）、75.0%（30/40）�'�66.7%（26/39）.The main supporting reasons were that this TB control modecould help each department better play its own advantages，and effectively usedmedical resource，and facilitate patient’s diagnosis and treatment. The mainreason not in favor of the “trinity” TB control mode was the insufficient publichealth resources in the general hospitals now.（2）The implementation schemeof the "trinity" TB control mode in Guangxi had been issued，the contents included the principle of the establishment of the TB designated hospital，theresponsibilities and requirements of each department，the supporting measures，the supervisions and evaluations，and so on.（3）The preparations for theimplementation of the “trinity” TB control mode in the16counties were asfollows：①The local implementation plan had been enacted in the16counties（100.0%，16/16）；②The work leadership group had been established in the12counties of all（75.0%，12/16）；③The leadership group meeting had beenheld in the11counties of all（68.8%,11/16）；④The meeting of leaders in everylevel health units organized by the health bureau had been held in the15counties of all（93.8%，15/16）；⑤The relevant information of the local TBdesignated hospital had been announced in the10counties of all（62.5%，10/16）；⑥The personnel training had been carried out in the11counties of all（68.8%，11/16）；⑦There were places，items and medicines for TB controlwork in more than80%of the designated hospitals；⑧There were personneltrained of the TB diagnosis and treatment，TB medicine management，and TBinformation management in more than80%of the designated hospitals，but therewere personnel trained of TB laboratory testing in the11counties of all（68.8%,，11/16）；⑨The TB control funds had been allocated based on theresponsibilities of every department in the7counties of all（43.8%，7/16）；⑩The preparation work had been carried out acceptance and evaluation in the7counties of all（43.8%，7/16）.（4）The TB diagnosis and treatment fees werebrought into the new medical insurance reimbursement for farmers，the medicalinsurance reimbursement for urban workers， and the medical insurancereimbursement for urban residents. In the three kinds of medical insurancereimbursement， there was not statistically significant difference in theminimum reimbursement of hospitalization expenditures（χ2=5.056，P=0.080）， but there was statistically significant difference in the minimum and themaximum reimbursement of outpatient expenditures and the maximumreimbursement of hospitalization expenditures（P<0.05），there were the highestproportions and amounts in the medical insurance reimbursement for urbanworkers. The TB diagnosis and treatment fees were brought into the civiladministration relief scope in the7counties of all（43.8%，7/16），the medianof the proportions and amounts of the reimbursement were50%and￥10000respectively. Conclusions （1）The implementation of the “trinity” TB controlmode was feasible in Guangxi，however this mode need to expand in a stepwiseway under the basic of improving the existing rules and regulations.（2）Theimplementation scheme of the "trinity" TB control mode as an instructionaldocument had important theoretical value in Guangxi.（3）It was importance tocarry out acceptance and evaluation for the preparation works，in order to insurethe establishment of the“trinity”TB control mode successful.（4）It waseffectively to bring the TB diagnosis and treatment fees into the medicalinsurance reimbursement and the civil administration relief scope， forfacilitating the establishment of the “trinity” TB control mode，but it still neededto improve the fairness，the scientificity and the normalization of the medicalinsurance mechanism.Section three：Analyze on the implementation situation of the “trinity”tuberculosis control modeObjective To investigate the implementation situation of the “trinity” TBprevention and control service system，exploring the countermeasures aiming atthe problems，in order to provide the scientific reference for implementing this TB prevention and control service system in Guangxi. Methods The17counties started to establish the “trinity” TB control mode on January1,2012toJanuary1,2013were selected， the data of the implementation situation of TBcontrol works were collected by organization investigation， key figuresinterviews，questionnaire survey，refering to relevant data，and so on，and tocarry out data analysis and evaluation. Results （1）The17counties wereeconomic development lag behind，minority and mountainous areas，each TBdesignated hospital was set in1local general hospital.（2）In the17counties，the implementations situation of responsibility works in each department wereas follows：①The health administrative department was responsible fororganization，coordination，and supervision in the TB control program. Thework coordination meeting was held once a year in the13counties of all（76.5%，13/17）；The supervision was carried out semiannually in the7counties of all（41.2%，7/17）；The work incentive mechanism was enacted inthe10counties of all（58.8%，10/17）；The matching funds of the county levelhad in place in the7counties of al（l41.8%，7/17）.②The CDC was responsiblefor supervision，training and carrying out the health education in the TB controlprogram. The main forms of the propaganda activities were carried out one-sitepropaganda activities and distributed the promotional materials on “3.24”world TB day in all the counties（100%，17/17）.③The TB designated hospitalwas responsible for the patients reporting，diagnosis and treatment，and carryingout health educations in the TB control program. The TB outpatient was set atindependent place in the13counties of all（76.5%，13/17）；The part-time dutypersonnel had the most proportion（88.2%，276/313）；The doctor for TBdiagnosis wear the N95respirator in5designated hospitals of al（l31.3%，5/17）；The wards for TB patients of smear sputum positive and smear sputum negative were set apart in3designated hospitals of all（17.65，3/17）.④The townshiphospital was responsible for patients recommendation for the suspected，patientssupervision for taking medicine；The part-time duty personnel had the mostproportion（87.5%，35/40）（.3）The results of the questionnaire survey in workerswere as follows：①There was statistically significant difference in theworkers work acceptability in CDC and in the designated hospital （χ2=7.510，P=0.006），the proportion of92.6%of workers in the designated hospitalconsidered it was feasible that the responsibility of patients supervision fortaking medicine was in CDC.②There were statistically significant difference inthe workers satisfaction degree on the workload，the staff treatment，and theoverall work in CDC and in the designated hospital（P＜0.05），the lowestworkers satisfaction degree was in the designated hospital，which was66.7%，54.3%and75.5%respectively.③The main difficult in TB control work for thestaff in the township hospital were that，there were not enough attention andworking funds in TB control work，and workers with limited working skills（.4）The results of patients visiting and questionnaire survey of36PTB patients wereas follows：①There were10patients of all could take medicine regularly and fillout the registration card according to the requiremen（t27.8%，10/36）；②Therewere21patients of all accepted workers supervision （58.3%，21/36）；③Therewere10patients of all gained medicine taking reminder（27.8%，10/36）；④There were10patients of all had the phenomenon of did not take medicine ontime（27.8%，10/36）；⑤There were21patients of all had the phenomenon ofclinic visit delay（58.3%，21/36）；⑥The patients satisfaction on the overalltreatment was73.1%（158/216）；⑦The patients satisfaction on the free policywas13.9%（5/36）.（5）The diagnose accordance rate of smear-negative PTBpatients was96.9%（126/130）in the17counties.（6）The results of comparing the implementation situations before and after the“trinity”TB control modeestablishment in the17counties were as follows：①In the aspect of TBdiagnosis and treatment，there was statistically significant difference in thesputum smears microscopy rate of the first visit patients（χ2=32.072，P=0.000），there was a higher rate after this mode establishment（62.3%，8452/13568）；②There was statistically significant difference in the register constituent ratio ofPTB patients （χ2=159.934，P=0.000），there was a lower register proportion ofthe smear-positive patients after this mode establishment（24.9%，1173/4717）；There was statistically significant difference in the source constituent ratio ofPTB patients（χ2=169.025，P=0.000），there was a higher proportion of PTBpatients from clinic visit due to symptoms after this mode establishment（45.0%，2125/4717）.②In the aspect of information input，there wasstatistically significant difference in the timeliness rate of the information inputwhen patients diagnosed （χ2=253.820，P=0.000），there was a lower timelinessrate after this mode establishment（78.9%，3724/4717）；There was statisticallysignificant difference in the information missing rate of the sputum smearexamination results（χ2=14.269，P=0.000），there was a higher informationmissing rate after this mode establishment（1.1%，51/4717）.③In the aspect ofthe supervision at the county level，the result of comparison before and after thismode establishment were that：the frequency of supervision had decreased by191after this mode establishment，the numbers of patients visit had decreasedby302after this mode establishment. Conclusions （1）It was reasonable ofrealizing the medical mode transformation for TB diagnosis， for making fulluse of the of the clinical advantages of general hospital.（2） After theestablishment of th“etrinity”TB control mode，it had played an important rolein detection and treatment of TB patients，and achieved a smooth transition of TB diagnosis and treatment work，as a result of each department doing workaccording to the responsibilities.（3） The main problems existing in theimplementation process were that：①The TB control funds were insufficient.②The personnel was insufficient，and the workers satisfaction was low.③Thesupervision and coordination of the TB control work conducted by the healthadministrative department were inadequate.④The quality of patientstherapeutic management was decline.⑤The economic burden of PTBpatients was heavy.（4）For perfecting th“etrinity”TB control service system，the suggestions were as follows：①It was needed to explore the effective fundscompensation mechanism.②It was needed to enhance the workers payment forstabilizing the personnel of TB control work.③It was needed to strengthen thesupervision and evaluation in the TB control work conducted by the healthadministrative departments.④It was needed to strengthen the personneltraining，and constantly standardize treatment management.⑤It was needed toperfecting the medical security system and huimin measures，for reducing theeconomic burden of PTB patients.