| Tuberculosis is one of the global chronic infectious diseases that has the longest history,and resulting most of the human deaths. Mycobacterium tuberculosis mainly through respiratory transmission, causing pulmonary infection disease, which is called the pulmonary tuberculosis, patients with discharged bacterium tuberculosis is a major source of infectious tuberculosis. In the past twenty years,the global epidemic situation of tuberculosis is serious, and has become an important public health problem in the world in nowadays.The number of TB patients,and the rate of incidence and mortality of infectious disease epidemic in China ranks No.1 in the world, and it is still serious.Objective:Master the current status of tuberculosis patients with smear positive two-way referral,and analysis the influencing factors of the two-way referral links at Chaoyang District in Beijing. Provides a basis to explore new mode of management of pulmonary tuberculosis infection in order to develop the two-way referral work norms reasonably and effectively.Methods:In Beijing Chaoyang District establish the two-way referral system organization for tuberculosis and tuberculosis hospital. TB institutions on the discovery of the smear positive patient referral to a specialist hospital for isolation,wait after the result become negative and transfer back to TB institutions to continue treatment. Then use the new mode of implementation the tuberculosis infectious source management of hospitalized patients with isolated infectious period.After finish collecting the date of patient’s information by using registration code, using EXCEL、Epidata 3.1 software to input the collected data and questionnaires into the establishment of the database.Compare and contrast the patient’s referral situation,age,sex,occupation,type of insurance,household registration,and reasons of refused to referral to do the final analysis.Result:1 The patients who refuse to referral have different classification. Local and migrant patients are 61.1% and 87.0%.Diabetics and non-diabetics patients are 60.3% and 80.1%. Tuberculous cavity and non-tuberculous cavity patients are 70.0% and 80.2%.The higher rate of referral rejection by NCMS and self-paid patients are 100% and 94.0%.The maximum rate of hospitalization by free medical service patients is 55.6%. The maximum rate of household income per capita under ￥10,000 patients is 97.8%.With the increasing of household income per capita, the rate of referral rejection is lower. With the increasing of age, the rate of referral rejection is lower, and the rate of referral agreement is higher.The patients,who are unemployed, employed and retired,have the quite higher rate of referral rejection than referral agreement.There is no significant difference in the marital status, education level, gender and main source of family income.2 With the multiple-factor analysis,the main influence factors of hospitalization are age, per capita annual household incomes, all symptoms score, marital status,medical insurance and tuberculous cavity in chest radiography.The patient who has older age,higher income and symptoms score tends to be in hospital with isolation treatment.Between the married and the unmarried, the married tend to be in hospital with isolation treatment. Compared with the NCMS and self-paid, the patients who are in free medical service and medical insurance tend to be in hospital with isolation treatment. The patients who have tuberculous cavity tend to be in hospital with isolation treatment.3 The main reason of referral rejection is that the treatment cost is too high,by the patients including migrant patients,diabetics patients,non-tuberculous cavitypatients,NCMS and self-paid patients,per capita household income under ￥30,000,college and university degree patients, different age patients and TB health education patients.Some patients who have no TB health education,master degree or above,more than ￥40,000 per capita household income, free medical service and be married reject referral for family or job reason.The patients who are without high school diploma, under medical insurance,with tuberculous cavity,local resident and unmarried have referral rejection for no need to be in hospital.4 Tuberculosis hospital 91 people, including 1 death during hospitallization,rule out TB 1, improved and discharged 89 people,including back Chaoyang District CDC tuberculosis outpatient treatment 78 people,accounting for 88%. Back to the tuberculosis hospital,11 patients,12%.Conclusions:1 Referral rejection decisions of smear positive pulmonary tuberculosis patients are influenced by many factors, such as household registration, age, occupation, marital status,type of insurance, household incomes per capita and working condition. There is no difference with gender, educational status and main family income source.2 Referral rejection reasons of smear positive pulmonary tuberculosis patients are higher cost,busy job or family affairs and no need of hospitallization.Higher cost is the main reason of referral rejection. If there is no guarantee of free service and compulsory measure, it is difficult to realize the infectious source of pulmonary tuberculosis management in hospital.3 Although CDC transferred from tuberculosis hospital patients hospitalized with poor compliance, the referral rate is only 22.6 % but the situation was discharged back to the CDC is more better, there are 88.0% of the patients can on request back to the CDC for further treatment. |
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