Investigation On Influencing Factors Of Tuberculosis Patients Reported By Hospitals Failed To Visit Designated Tuberculosis Clinics

ObjectiveTo explore the influencing factors of tuberculosis patients reported by hospitals failed to visit designated tuberculosis clinics, and to provide scientific evidence for government to help develop tuberculosis prevention and control measures.MethodsEight counties were selected in the study, including Chaoyang District and Tongzhou District of Beijing, Kashgar City and Yengisar County of Xinjiang, Zunyi county and Xingyi City of Guizhou, Baoan District and Longgang District of Guangdong. Case-control study and qualitative interviewing were used in the study.1. Case-control studySelection of cases:226 patients reported by hospitals failed to visit designated tuberculosis clinics in China Information System For Disease Control and Prevention in these eight counties were selected as cases, and were administered a structured questionnaire. Selection of controls:235 patients reported by hospitals succeeded to visit designated tuberculosis clinics in China Information System For Disease Control and Prevention in these eight counties, were administered a same structured questionnaire. Analysis of data:Data were analyzed using Pearson chi-square test and logistic regression in SPSS 18.2. qualitative interviewingStaffs from local health administrative departments, general hospitals and designated tuberculosis clinics were interviewed on influencing factors of tuberculosis patients reported by hospitals failed to visit designated tuberculosis clinics.Analysis of data:Main influencing factors were concluded by comparing the different interview.ResultsCase-control study showed that ten influencing factors were related to tuberculosis patients reported by hospitals failed to visit designated tuberculosis clinics, including floating population (OR=6.89), self-treatment (OR=3.13), high education level (OR=2.24), mistrusting designated tuberculosis clinics (OR=2.16), transportation cost≥10 yuan (OR=2.09), time-consuming distance>45 minutes (OR=1.90) and going to hospital many times (OR=2.03). Three protect factors were having no test of sputum smear in hospitals (OR=0.56), having an advice from doctors for referral (OR=0.30) and laboratory diagnosis (OR=0.21).Interview data analysis showed that the common causes of tuberculosis patients and suspects not being referred to designated tuberculosis clinics included hospitals retaining cases, doctors not performing standardized referral operation, floating population returning to hometown, folk prescription or self-therapy, the service of designated tuberculosis clinics not gaining social acceptance, inconvenient to the traffic of going to designated tuberculosis clinics.ConclusionFloating population, patients with high education level, or having mistrust of designated tuberculosis clinics, or traveling long distance to designated tuberculosis clinics were unlikely to visit designated tuberculosis clinics, whereas patients advised to refer to designated hospitals, and laboratory diagnosed tuberculosis cases were more prone to seek medical care in designated tuberculosis clinics.Recommendations For Health Administrative Department1. By taking account of the size of the area and the local transportation status, designated tuberculosis clinics should be located where is convenient for patients to visit doctors or refer.2. Relevant inspection, performance evaluation and reward and punishment systems should be established so as to standardize the doctor's medical practices.3. Circulation of antitubercular agents should be under strict inspection, united with drug administration institute, to avoid self-treatment phenomenon.For Designated Tuberculosis Clinics1. To enhance health education towards floating population regarding tuberculosis prevention and control knowledge.2. To improve the ability of tuberculosis treatment, and to strengthen the publicity of designated tuberculosis clinics.3. To enhance the timeliness of tuberculosis case-tracing, especially towards those floating population, and to inform the address and contact information of the designated tuberculosis clinic simultaneously.For Medical InstitutionsWhile conducting sputum smear, doctors should explain to the patients very patiently regarding the purpose and results of the test, and those suspected patient with smear-negative result should be encouraged to seek further examination at designated tuberculosis clinics.