| According to the estimates of World Health Organization,there are 8.4 million new tuberculosis patients in the world each year, of which 95 percent are in developing countries; And the TB deaths each year are 2 million, of which 98% occur in developing countries.75% of patients aged 15-50 years old, which caused the patient's household and the community a heavy financial burden and economic losses. The Tuberculosis epidemic situation in China is similar to the world. China is the world's highest burden of TB in 22 countries, TB prevalence in the world, second only to India. It is estimated that the total number of TB patients in China accounts for a quarter of the world, of which 80% of TB were found in the vast rural areas, especially in old, small, side, and poor areas of tuberculosis epidemic situation is much worse. TB in rural China has become to shake off poverty, constraints, especially in poor areas of rural economic and social development of major diseases.Objective:TB patient is an important position to work is also the first pass TB. In the current medical conditions, the vast majority of TB patients in selected out-patient treatment after diagnosis. TB patients to assess the level of out-patient service use, put forward practical countermeasures, we used a questionnaire form, was investigated. This study used stratified random sampling method, investigated a total of 819 TB patients, of which over 501 patients in the treatment of tuberculosis. All survey data from the Shandong University Social Medicine and Health Management Research Institute Unicode collation, organization staff input, by checking the data is correct, no omissions, the use of SPSS 13.0 and SAS9.1 software for statistical analysis.The survey included:①socio-demographic characteristics of patients;②family economic status of patients;③health promotion case;④patients diagnosed before and after the expenditure of medical expenses;⑤patients on TB control project-related policy issues and evaluate the situation;⑥patient subjective evaluation and reaction.Methods:The method of stratified—cluster-random sampling Was used in this study, and six counties, thirty-six towns were taken out. SPSS13.0 and EXCEL 2003 were used in this article. Descriptive analysis, Chi—Square Test, Kruskal—Wallis H test and ordinal regression were used in the process of data analysis.Main results:1. Basic.819 594 males surveyed, accounting for 72.5%, female 225,27.5%; 30 years of age accounted for 14.9% of 30-44 15.4% 45 to-59 years old accounted for 26.7%,43.0% aged over 60; education:36.5% were illiterate,24.5% of primary school,27.4% middle school, high school or college or 11.7%; Occupation: 80.0% for the farmers,20.0% of non-farmers; Marital Status:Unmarried 12.9%, 76.3% married,10.8% divorced or widowed/living alone.2. When the symptoms first doctor.819 surveyed,75.2% of patients cough when the initial visits,45.8% had fever, symptoms of body temperature below 39 degrees, 44.1%, expectoration, chest tightness and shortness of breath 34.2%,25.4% and night sweats, bloody sputum 12.1%,11.7% hemoptysis, fever 9.2%, body temperature higher than 39 degrees,15.4% had other symptoms.3. First medical doctor.31.0% of the overall survey of patients in the initial visits to village health care institutions,17.0% of township hospitals,13.1% for the tuberculosis control institutions,33.0% for the county general hospital,6.0% other medical institutions.48.0% of patients in the initial choice of medical care units and village clinics township hospitals. Gender, occupation, health insurance on the first tuberculosis patients were not significantly different medical care units; age difference was statistically significant, increase with age, choose the village clinics and township hospitals increased the number of patients visits; education significantly, lower education level, select the village clinics and township hospitals more patient visits; marital status significantly, divorced or widowed/living alone, patients select village health and rural hospitals with high attendance in other patients.4. The initial visits of diagnosis. Only 444 (54.2%) patients diagnosed with tuberculosis when the initial visits, and the remaining 375 (45.8%) patients were misdiagnosed, the patient was misdiagnosed as the common cold the most, accounting for 25.6%, the rest were diagnosed as bronchitis, bronchitis, pneumonia, etc.. More than one village health diagnosis was a cold, diagnosed as pulmonary tuberculosis accounted for only 13.0%, rural hospitals and medical institutions for more than a higher rate of correct diagnosis, particularly in the county TB control agencies to the highest, accounting for 90.7%.5. Doctor delays from the first symptoms of tuberculosis patients to the doctor the first time interval of 27.72 days on average, up interval of 1080 days, minimum interval of 0 days.283 (34.6%) patients experienced a delay visits, the average delay in 73.25 days. Different gender, age, education, occupation, health care visits to the delay in tuberculosis patients were not significantly different; marital status differences were statistically significant delay of unmarried patients experienced doctor than other patients. The reasons for the delay occurred visits,56.6% of patients do not realize is tuberculosis,29.6% do not care,8.5% economic difficulties,4.3% in no time,1.0% selected other.6. Confirmed the situation.819 survey, the distribution of medical diagnosis was: 75.6% of TB patients in institutions for the county,10.7% for the county general hospital,7.3% for the municipal tuberculosis control institutions,1.8% of township hospitals,4.6% other. Different gender, age, education, occupation, marital status, medical care unit on the diagnosis of pulmonary tuberculosis were not significantly different. From the initial visits to the diagnosed TB patients 2.51 times the average attendance up to 30 visits.7. Diagnosis delays. Tuberculosis patients from the initial visits to the average interval between diagnosis of 16.45 days, a maximum interval of 2160 days, at least interval 0 days.182 (22.2%) patients diagnosed with delayed occurrence of the phenomenon, the average delay in 66.01 days. Different gender, age, education, occupation, marital status, medical care diagnosis of tuberculosis patient delay of occurrence was not statistically significant.Conclusions:The survey found that tuberculosis patients more than when the initial visits have cough, sputum with fever symptoms. Nearly half of the initial visits of patients choose to village clinics or township hospitals, especially older, low educational level or divorced or widowed/living alone, patient preference obviously. Nearly half of the initial visits of patients were misdiagnosed, many diagnosis of diseases such as influenza. Part of the patient visits a delay occurs, the reason is not aware of a TB and do not care. This may be the health workers do not have good knowledge to villagers about tuberculosis, delayed diagnosis. From the initial visits to the doctor more frequently diagnosed during the patients, some patients diagnosed with delayed occurrence of the phenomenon, most patients eventually diagnosed with tuberculosis control institutions, more intermediate links, increase the financial burden of patients. Medical institutions, medical personnel do not understand free TB diagnosis and treatment policy, or driven by economic interests, dilute referral consciousness, for their own interests at the expense of the demand-side interests, seriously affected the fairness and efficiency of health services, leading to the diagnosis of pulmonary tuberculosis patients delay.recommendations:To solve the above problem, the proposed emphasis on primary health personnel departments role in TB control and strengthen the work of medical practitioners involved in TB prevention and control of professional training, development of a number of easy to understand and grasp the learning materials so that they understand the significance of tuberculosis control, strategies and measures, to master knowledge of TB, improve the identification of tuberculosis-like levels, reduce misdiagnosis, and effectively improve the detection rate of patients. Increase knowledge of the villagers tuberculosis propaganda, especially tuberculosis, free checks, free medical treatment policies, so that the villagers aware of the dangers of tuberculosis and the increase in TB prevention and control knowledge, to reduce the phenomenon of delayed attendance. Clearly defined medical diagnosis, discovery, and referral procedures for suspected tuberculosis symptoms, an appropriate incentive mechanism to encourage timely and effective referral and reporting of cases, prevent the occurrence of the phenomenon of delayed diagnosis, improve accuracy in diagnosis of pulmonary tuberculosis patients in the initial efforts to tuberculosis patients and the community to reduce the financial burden. Give full play to the advantages of outpatient treatment to minimize the number of hospitalized patients, thereby reducing the patient's medical expenses.
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