| Research BackgroundTuberculosis, an ancient infectious chronic disease that severely endangers human health, results from the infection of mycobacterium complex and is primarily spread through the respiratory tract. At present, there are approximately20million patients with active pulmonary tuberculosis all over the world and about8to10million new patients with tuberculosis every year, while nearly3million people annually die from tuberculosis. China is one of the countries where tuberculosis is prevalent in the world and its epidemic situation is characterized by high prevalence, high mortality, high rate of drug resistance and low annual rate of decline. The data suggest that the prevalence of active pulmonary tuberculosis is3.67‰, among which the prevalence of bacteriologically-positive tuberculosis and smear-positive tuberculosis are1.6‰and1‰respectively.80%tuberculosis patients are from vast rural areas and rural residents are still the key population who shall be protected from tuberculosis in China. Over the past few years, numerous studies have been conducted in China in the fields of tuberculosis control, whereas very few studies have been done for the incidence, the treatment and the diagnostic interval of tuberculosis. The present research mainly focuses on Shandong tuberculosis patients’ utilization of health services and factors affecting time interval between hospital visits. Besides, the author explores existing problems for treating tuberculosis patients to improve the accessibility of health services and time interval between hospital visits, in order to provide references and basis for better preventing and treating tuberculosis and reasonably developing health policies.Research Objective The major objective of this research is to clarify tuberculosis patients’utilization of health services and define factors influencing their utilization to examine factors that affect tuberculosis patients’incidence, treatment and diagnostic intervals by conducting a survey on tuberculosis patients in Shandong Province, for the purpose of providing references for developing pertinent measures to treat, prevent and intervene pulmonary tuberculosis.Materials and MethodsThe materials of this research were collected from the "Research on Effective Evaluation of Incentive Policies for Tuberculosis Control Project and Expected Incentive Policies" conducted by Shandong University’s Institute of Social Medicine and Health Management in six counties (districts) of Shandong Province within the period from December of2007to February of2008. According to design requirements, Binzhou, Jining and Zaozhuang were determined as the fields where the survey was conducted by stratified and cluster random sampling based on GDP per capita. Then, two prefectures (cities or districts) were randomly selected from each prefecture-level city. All villages and towns of investigated prefectures were arranged in order pursuant to the number of population. Six villages and towns were selected from each prefecture at random by systematic sampling.36villages and towns were sampled in total, where patients with pulmonary tuberculosis registered from1st September of2006to31st August of2007were respondents of the questionnaire survey.A database was established by Epidata and processed by SPSS13.0. Meanwhile, related data in the database were examined by comparative analysis, descriptive analysis and multivariate analysis according to the content and data to be researched.Main Results1. For patients with pulmonary tuberculosis, the time interval between the earliest onset of symptoms and the first hospital visit was25.46days on average, which was0at least and1,080days at most. Patients who went to hospitals within1,2,3to4, and more than4weeks after their earliest onset of symptoms respectively accounted for55.81%,11.48%,10.95%and21.76%. As regards the distribution of patients in medical institutions, comprehensive prefecture-level hospitals, village clinics, health clinics of towns and townships, institutions for tuberculosis prevention and control, and other medical institutions respectively occupied32.44%,31.38%,17.22%,12.95%and6.01%.2. As to patients with pulmonary tuberculosis, the time interval between their first hospital visit and definite diagnosis was0day at least and2,241days at most, which was15.88days on average.69.83%,9.61%,9.61%,8.41%and12.15%of patients were accurately diagnosed within1week,2weeks,3to4weeks and over four weeks respectively after their first hospital visit. The definite diagnoses were respectively made in prefecture-level institutions for tuberculosis prevention and control (73.97%), comprehensive prefecture-level hospitals (13.62%), municipal organizations for tuberculosis prevention and control (7.88%), health clinics of towns and townships (2.00%), and other medical institutions (4.6%).ConclusionsThe epidemic situation of tuberculosis is stable with low incidence in Shandong Province, whereas the number of smear-positive pulmonary TB patients registered tends to increase year by year. More males suffer from tuberculosis than females and most of them are aged. Nevertheless, there has presented a remarkable increase in the number of young tuberculosis patients in recent years. These young patients are mostly farmers who are poorly educated and from relatively poor families. Tuberculosis patients know little about tuberculosis and rarely take the initiative to consult or search related knowledge about tuberculosis prevention and control after suffering from the disease. Grassroots medical workers’ abilities to correctly diagnose pulmonary tuberculosis remain to be further improved. Factors that affect the time interval between hospital visits mainly include occupation, families’ financial conditions, time that shall be taken from home to a health clinic and knowledge about preferential policies of subsidies and so on. Grassroots medical institutions’ professional competence and technical conditions are major factors that impact the diagnostic interval.SuggestionsEfforts shall be made to further publicize the knowledge about tuberculosis prevention and corresponding treatment policies, particularly the policies for identifying symptoms of suspected pulmonary tuberculosis (PTB), diagnosing and treating pulmonary tuberculosis free of charge. It is necessary to further improve the coverage of medical insurance and regulate the layout of medical institutions to increase the accessibility of medical services to patients with pulmonary tuberculosis. The dual referral system shall be reinforced so that tuberculosis patients can be timely transferred to tuberculosis control centers to receive regular treatment for the purpose of reducing patients’time for definite diagnosis and burdens. Long-term training systems shall be established for training rural doctors to improve their knowledge and skills for identifying and diagnosing tuberculosis. Physical examinations shall be regularly conducted for key tuberculosis patients and organizations where there were tuberculosis patients in the past, in hope of early detection and diagnosis to make early hospital visits. An atmosphere of caring for tuberculosis patients shall be created in the whole society. Besides, there is a need to insist on implementing national free policies, increase capital investment, issue preferential policies and incorporate pulmonary tuberculosis into new medical insurance systems about rural cooperative medical services and treatment of serious diseases, in order to progressively increase the reimbursement rate for patients with pulmonary tuberculosis and reduce tuberculosis patients’financial burden for the disease. |
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