| ObjectivesTo understand the choice of medical institutions,the law of medical flow direction,and the delay of medical treatment of colorectal cancer patients,so as to provide the basis for improving the grading diagnosis and treatment system of colorectal cancer and other malignant tumors,and for intervening the medical behavior of colorectal cancer patients.Methods1.Based on the big data of the front page of the medical records,the flow of CRC patients'medical treatment was analyzed:the data of the front page of the medical records of CRC patients in Sichuan Province from 2015 to 2018 were collected,the trend chi square test of the prevalence rate was carried out with SPSS 19.0,and the thermal chart was drawn with R language remap.2.Qualitative analysis of medical delay of CRC patients:using self-designed interview outline,convenient sampling method to select CRC patients from Sichuan cancer hospital for interview,using theme framework method to code and analyze in NVivo 11.0.3.Quantitative analysis of CRC patients'delay in seeking medical treatment:refer to the results of qualitative interviews and literature design questionnaire,use convenient sampling method to select CRC patients from Sichuan cancer hospital for questionnaire survey,conduct single factor analysis through chi square/rank sum test,and conduct multi factor analysis through logistic regression.Results1.Analysis of the flow of patients'medical treatment based on big data on the front page of medical recordsFrom 2015 to 2018,there were 89,448 CRC patients in Sichuan,with an annual prevalence of 17.9-43.9 per 100000,showing an upward trend(trend?~2=10952.8,P<0.001).(1)Flow direction of medical institutionsCRC patients were mainly hospitalized in tertiary hospitals(78.3%)and general hospitals(81.7%).A total of 10,349 patients were admitted to more than one medical institution,and the mobile diagnosis and treatment rate was 11.6%.The main flow direction of medical institutions were general hospital-TCM(general)hospital(19.1%),tertiary hospital-Secondary Hospital(42.8%).(2)Flow direction of medical treatment areaThere were 13,055 CRC patients in different places,and the rate was 14.6%.(1)Inflow:Chengdu has the largest inflow,36,687 people,with an inflow rate of 49.3%;Panzhihua City has the second largest inflow,with a total of 2,176 people,with an inflow rate of 31.0%.(2)Outflow:Liangshan state has the largest number of outflow,3,110 in total,followed by Meishan City,3,071 in total.ABA has the highest outflow rate(89.2%),followed by Ganzi(85.4%).2.Qualitative analysis of medical delay of CRC patientsA total of 60 CRC patients were interviewed,and most of them(36/60)had delayed their visits.The reasons were:(1)the main reason(11/6)was the lack of colorectal cancer related knowledge,(2)the secondary reason(10/36)was the lack of health awareness.Half of the patients(30/60)had delayed diagnosis because:(1)the main reason(8/30)was missed diagnosis,(2)the secondary reason(7/30)was misdiagnosis.A few patients(6/60)had delayed treatment,and the main reason(2/6)was bed waiting.3.Quantitative analysis of the delay of CRC patientsA total of 110 people were investigated and 93(84.5%)responded.79.6%of the patients had delay in treatment,the main reason was that the patients did not pay attention to the symptoms as enteritis and other diseases.Multivariate analysis showed that the risk of delay was 3.872 times higher in men than in women(or 3.872,95%CI1.010-14.846).Patients who did not know the symptoms of colorectal cancer before the disease were 4.831 times more likely to delay their visit(or 0.207,95%CI0.052-0.820).ConclusionsCRC patients are mainly treated in tertiary general hospitals,and the proportion of cancer hospitals is relatively low.CRC patients mainly flow into areas with rich medical resources and high medical level,and mainly flow out of ethnic remote areas.Most of CRC patients have delay in treatment,the main reason is personal factors,the main reason for delay in diagnosis is medical institutions.Suggestions:(1)individuals should take the initiative to learn the knowledge of colorectal cancer prevention and control;medical and health institutions should implement accurate health education on colorectal cancer prevention and control.(2)Family members should support medical treatment after finding that their relatives have symptoms.(3)Colorectal cancer screening can be included in the physical examination of employees.(4)Through training,medical consortia and so on to improve the diagnosis and treatment level of grass-roots medical institutions;cancer hospital to strengthen publicity.(5)The administrative department of health should guide the establishment of tumor referral system.(6)The medical insurance department can include colorectal cancer screening into the scope of medical insurance payment. |
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