| Background:There are many problems on TB control in TB special hospitals, such as low referral rate of TB patients, abusing second line anti-TB drugs and low success treatment rate of TB cases. In order to standardize the process of diagnosis and treatment in TB special hospitals and establish an effective cooperation system with TB dispensaries, China CDC launched a pilot study to standardize activities for TB patients in 4 TB special hospitals, and the on-site intervention has been accomplished by June 30,2010,.Considering the advantage of TB special hospitals for diagnosis and treatment, some studies suggest that TB special hospitals must be involved in TB control. However, the responsibilities of TB hospitals have not been determined. It is necessary to evaluate the pilot of TB hospitals, and learn lessons how to facilitate TB control by utilizing TB hospitals.Purpose:To get to know the status of TB patients identification, register and reporting and treatment management in TB special hospital;To assess the results of pilot of TB special hospital and to evaluate intervention method's effectiveness in standardizing TB diagnosis and treatment in TB special hospitals;To explore suitable roles and responsibilities of TB special hospital in National TB Programme and to provide suggestions for improving the cooperation between TB dispensary and hospital.Method:To collect in-patients' data of sputum examination, reporting, treatment regimen, referring and information deliver, register status in TB dispensary and treatment outcome to evaluate results of pilot by quantitative method; To understand the attitude, opinion and suggestion of the pilot from stakeholders by one on one interview;·To gather relevant information from in-patients'record and register documents by purpose sampling. The considered factors when sampling included hospital's size, research targets' amount and pilot beginning date;·To analyze data using SPSS 13.0 statistics software. Descriptive statistics results has been presented including rate, ratio and means for in-patients' epidemic situation reporting, treatment plan, referral and register indicators. In the mean time, non-parameter test method has been adopted in the research to evaluate if the different results have statistical difference or not.Results:·Sputum examination:the sputum smear rate is 83.2%, the sputum culture rate is 31.0% and the non-examination rate is 16.8% before the pilot; the sputum smear rate is 91.8%, the sputum culture rate is 37.9% and the non-examination rate is 7.6% during the pilot period;·Treatment regimen for new TB cases:only 101 cases (23.4%) are prescribed with the standard regimen of 4 first-line anti-TB drugs before the pilot; 403 cases (44.9%) are prescribed with the standard regimen during the pilot.·Patients referring and information delivering:the overall referral rate before and during the pilot is 30.3% and 81.4% respectively; the patients' information delivering rate of 3 TB hospitals is 100%, that of the rest one is 59.7%.·Patients registration in TB dispensaries:only 28.5% of inpatients diagnosed in 4 TB hospitals have been registered before the pilot; 74.6% of inpatients have been registered during the pilot.·Treatment outcome:the overall successful treatment rate is 44.7% before the pilot, that is 54.3% during the pilot. Conclusion:Before pilot, there were universal problems such as applying non-standardized treatment regimen for new TB patients, abusing second line anti-TB drugs and low referral rate in TB special hospitals. These problems made TB dispensaries can not detect, register and manage patients successfully and effectively. After pilot intervention, the effectiveness of TB control in 4 hospitals has been all improved. But there are significant differences between the changes of indicators in 4 targeted hospitals. In a word, the general results of pilot are good. The pilot intervention is a successful beginning in standardizing treatment behavior for TB special hospital. |
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