| Objective:1.Investigate the reasons for repeatedly hospitalization of pulmonary tuberculosis patients through analysis the medical records of tuberculosis patients in 2013 more than 2 times. Then find the infect the hospitalization time and the influence factors of multiple hospitalization in patients with pulmonary tuberculosis.2.To investigate the social and individual factors that infect the hospitalization frequency, a questionnaire survey was performed by repeatedly hospitalized patients with tuberculosis and tuberculosis specialist doctor.3.This study not only provides the basis for constitution of policies, regulations and subsidies but also supplies the evidences for reduction of the medical burden of patients and perfection of all kinds of medical insurance compensation system.Methods:1.descriptive statistics analysis:Retrospective investigation was performed by analyzing the medical records of patients with pulmonary tuberculosis hospitalization through the Hospital Information System (HIS) from one Chest hospital. Describe the features of patient and the reasons for repeatedly hospitalization of pulmonary tuberculosis patients.2.single factor analysis:Univariate analysis was used to study the correlation between the frequency of hospitalization and age, gender, household registration, Whether or not combined with other diseases and payment methods of medical expenses.3. The matic questionnaire designed and surveyA questionnaire survey by multiple hospitalized patients with pulmonary tuberculosis and pulmonary tuberculosis specialist doctor, Firstly, a general survey was carried out to Describe the knowledge and treatment compliance of repeatedly hospitalized tuberculosis patients. The questionnaire also included the demand for the government, various medical insurance agencies, tuberculosis specialist hospital, and community health agencies. Secondly, questionnaire survey by tuberculosis specialist was also used to recognize the Specialist physicians' views on reasons of tuberculosis patients hospitalized several times and the treatment tendency of patients with aspects of the different payment methods.Results:1.Describe the reasons for repeatedly hospitalization of pulmonary tuberculosis patients and analyze its influence factors:339 multiple hospitalized patients with pulmonary tuberculosis reached 806 cases of hospitalization within one year. The average hospital stay was 2.38 times.The top three reasons for hospitalization are required interventional therapy, condition deteriorated, and side effects of anti-TB drugs.60.42 percent of all 806 cases had chronic diseases, in which cardiovascular diseases, diabetes and respiratory failure are most prevalent The main causes of hospitalization were deterioration of the disease, interventional treatment and the side effects of anti tuberculosis drugs; with respect to local urban patients, were least likely to repeatedly hospitalize. Moreover, the hospitalization frequency of local suburb patients is less than the urban patients.2. Household Registration is considered statistically significant in univariate analysis of influencing Factors on multiple hospitalizations of patients with pulmonary tuberculosis. Multivariate stepwise regression analysis in different registered patients showed that the nonlocal censuses register patients, with respect to local urban patients, were least likely to repeatedly hospitalize. Moreover, the hospitalization frequency of local suburb patients is less than the urban patients.3. In this study,135 questionnaires of pulmonary tuberculosis were issued, and 130 cases were valid, rate of recovery 96.3%,There are 72 men (55.38%) and 58 women (44.62%) in all 130 respondents and the male-to-female ratio was 1.24:1. The oldest was 86 years old and the youngest is 15 years, the average age of the age was 30.5±16.488 years of all respondents. Patients with the degree of culture to college and above accounted for 50.8%(66/130) of all participants, which is the largest part of the population surveyed.(1)The awareness rate of repeatedly hospitalized tuberculosis patients:The awareness rate of tuberculosis patients is very low, and the recognition rate is very low. The overall awareness rate is 20.8%(243/1170) and only 6.92%(9/130) of the patients know all the tuberculosis related knowledge.40.77%(53/130) of all patients know "Tuberculosis is a chronic airway infectious disease", which was with the highest awareness. The lowest three awareness of the tuberculosis related knowledge were "Government subsidy policy for TB patients", "Sterilization and isolation methods for TB patients", and "Known side effects of anti-TB drugs", and the awareness rate isUnivariate analysis about cognition of patients with tuberculosis found that "whether or not combined with other diseases", "education level", "household register", and "Annual household income" has the statistical significance. Multiple linear regression analysis found that the nonlocal censuses register patients had less aware of TB-related knowledge and the lower the education level in patients with lower cognitive level.(2)Treatment Compliance of multiple hospitalized patients with tuberculosis:The overall treatment compliance was 61.6%(641/1040) in all patients. "The Timely referral in accordance with the doctor ordered" was the highest awareness of TB-related knowledge in patients, and the awareness rate of which reached 80.8%(105/130). The second highest awareness of TB-related knowledge was "Follow the doctor commanded to take medication", and the awareness rate of which reached 77.7%(101/130). Univariate analysis about treatment compliance of patients with tuberculosis found that "Education level" and "The age" has the statistical significance. Multiple linear regression analysis showed that the lower the education level in patients with worse treatment compliance and the treatment compliance of hospitalized patients is better than that of outpatients4.The tuberculosis specialist physician's questionnaire survey research:The study sent out 27 questionnaires to the specialist doctors and all the questionnaires were fully recovered and effectively. Wherein the specialist doctors the proportion of male and female was 1:2. The specialist doctors included junior titles, intermediate grade, and senior, the ratio of which was 1:1:1.51.85% of specialist physicians working years concentrated in 5-15 years. Specialist doctors all agreed that the disease progression and combination with other diseases is the two main reasons for multiple hospitalizations in patients with tuberculosis. In the patient's payment method,74% of specialist doctors prefer to treat patients with health insurance.In addition, the side effects caused by anti tuberculosis drug treatment are common.Suggestion:The first, We suggested that the government departments to improve tuberculosis related costs of subsidies, such as the transportation, nutrition and hepatoprotective drug subsidy. Meanwhile, at the same time, anti TB drug research funding and policy support should be increasing to reduce the toxic side effects caused by free anti-TB drugs.Then,Improve the medical insurance policy support, The scope of reimbursement and compensation mechanism of medical expenses is not enough for the hospitalization and outpatient patients with pulmonary tuberculosis, especially for the patients who need interventional treatment that is time consuming and high cost. The complicated procedures and the less reimbursement rate of medical expenses also have an adverse effect on medical treatment of the nonlocal censuses register patients.The last,The complicated procedures and the less reimbursement rate of medical expenses also have an adverse effect on medical treatment of the nonlocal censuses register patients. It is very important to strengthen supervision of medical insurance funds and simplify the reimbursement procedures and so on. |
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