| Objectives:To understand the willingness of diabetic patients to accept the implementation of tuberculosis suspicious symptom screening,chest radiography and sputum smear examination under different modalities,and to explore the factors influencing the willingness of diabetic patients to accept.To understand the allocation of equipment and human resources related to active TB screening for diabetic patients in primary health care service institutions in Yunnan Province in combination with the national basic public health service model.To understand the current processes and specific models of active TB screening for diabetic patients in combination with basic public health services in different regions of Yunnan Pro vince,and to obtain the knowledge and suggestions of health service providers on active TB screening for diabetic patients in combination with national basic public health services.Methods:This study used a cross-sectional survey method,and the survey was divided into three parts:(1)687 people who were included in the health management of diabetic patients in three township health centers in Yiliang County,Kunming City,Chuxiong City,Chuxiong Prefecture,and Zhaoyang District,Zhaotong City,were selected to collect the willingness of diabetic patients to receive TB symptom screening and related examinations by means of a face-to-face questionnaire,and to collect the information on the influence of The factors influencing the willingness of diabetic patients to receive tuberculosis screening were also collected.(2)A survey was conducted on the resource allocation of 50 township health centers in three selected counties to collect information on the allocation of tuberculosis and diabetes-related screening equipment in township health centers and the basic information on the health technicians undertaking basic public health services.(3)Qualitative interviews were conducted with rural doctors who were responsible for the management of diabetic patients and tuberculosis patients in the work of basic public health services in the three selected township health centers,in terms of the process of tuberculosis screening for diabetic patients,difficulties encountered in the process,and ways of improvement.The number of X-ray machines in township health centers and the basic situation of village doctors were used to describe the willingness of diabetic patients to receive screening,and statistical methods such as chi-square test and dichotomous logistic regression analysis model were applied to explore the influence of different demographic characteristics,access to medical care and disease on the willingness to receive screening,with a test level of α=0.05.Results:1 Diabetic patients basic information:687 cases of diabetic patients were mainly female,with 436 cases,accounting for 63.46%;the median age was at 65 years old,the lowest age was 18 years old,and the highest age was 90 years old,with the largest number of people in the 65-74 age group,accounting for 39.45%;most were Han Chinese(97.23%);occupation was mainly farmers,accounting for 68.27%;education The highest proportion of people with elementary school level was 42.65%;among the diabetic patients in this survey,the median annual per capita household income was RMB 60,000,with 353 people(51.38%);the median annual per capita household medical expenditure was RMB 1,000,with 373 people having annual per capita household medical expenditure≥RMB 1,000.The median number of years of diabetes was 4 years,of which 392(57.06%)had diabetes for ≤4 years;9(1.13%)reported having tuberculosis;631(53.71%)received follow-up visits from village doctors once ≤3 months,and 581(84.57%)were followed up during outpatient visits to the village health office or township health center.The frequency of blood glucose measurement was 1 time ≤3 months for 441 people(64.19%);458 people(66.67%)did not need to be accompanied during their daily visits.There were 316(46.00%)people who thought that TB was an infectious disease and 224(32.61%)people who thought that diabetic patients were more likely to get TB.2 Willingness of diabetic patients to be screened for TB symptoms:576 people(82.53%)were very willing to be screened for suspicious symptoms of TB when they went to the village health office or township health center outpatient clinic;41 patients(5.97%)were somewhat willing;25 people(3.64%)had a neutral attitude;37 people(5.39%)were somewhat unwilling to be screened.5.39%;and 17(2.47%)were very reluctant to be screened.Among the 79 patients who were somewhat willing,neutral,somewhat unwilling,and very unwilling to be screened for TB symptoms at the outpatient clinic visit,37(46.84%)thought the problem of screening for symptoms was too cumbersome,56(70.89%)thought TB was not serious,19(24.05%)were worried about spending money on treatment after screening for TB,and 11(13.92%)were not convenient to reach the screening site.Two(2.53%)were busy with work and farming and had no time to attend the screening.When diabetic patients were asked whether they were willing to be screened for suspicious symptoms of TB if they were followed up by the village doctor at home,612(89.08%)said they were very willing;38(5.53%)said they were somewhat willing;11(1.60%)said they had a neutral attitude;16(2.33%)said they were somewhat unwilling;and 10(1.46%)said they were very unwilling.1.46%).Logistic regression analysis showed that the willingness of 86 people changed when comparing the two methods of symptom screening at the time of visiting the village health office with the symptom screening at the time of the household follow-up visit.78 people(90.70%)were more willing and 8 people(9.30%)were less willing than the former method of symptom screening at the time of the household follow-up visit.Diabetic patients living in urban areas were more willing to undergo TB symptom screening than those living in rural areas,(OR adjusted=2.146,95%CI=1.151 to 4.003);those who believed that diabetic patients were more likely to develop TB were 1.934 times more willing to undergo symptom screening than those who denied this belief.(OR adjusted=1.934,95%CI=1.089 to 3.435).3 Willingness to receive tuberculosis-related screening 687 diabetic patients were willing to go to the county hospital/township health center to receive a chest X-ray examination at their own expense if they had suspicious symptoms of tuberculosis at the time of tuberculosis screening by the village doctor,603 of them said they were willing to receive it,accounting for 87.77%,and 84 were not willing to receive it,accounting for 12.23%.If the chest X-ray examination was free,the number of people who were willing to accept it was 657(95.63%),which was an improvement of 7.86%compared with the self-pay examination,and 30 people(4.37%)were unwilling to accept it.Among the 84 people who were unwilling to accept self-pay chest X-ray examination,33 people(39.39%)were worried about the cost;10.71%of the patients had chest X-ray in the past 3 months with no abnormal results,32.14%of the patients thought they were not sick,21.43%of the patients thought it was too far to travel to the hospital,and 19.05%of the patients thought they were too old to travel.Logistic regression analysis showed that those who believed that diabetic patients were more likely to get tuberculosis had a higher degree of willingness to undergo self-pay chest radiographs,1.907 times more than those who did not think so.(OR adjusted=1.907,95%CI=10.76 to 3.381).Diabetic patients were asked whether they were willing to go to the county hospital/township health center for self-pay sputum smear examination in case of abnormal chest radiograph results when they underwent chest radiograph examination,and 611 of them,or 88.94%,said they were willing to undergo it.A total of 76 patients were not willing to receive self-funded sputum smear examination,67.11%were worried about the cost of treatment after detecting TB,28.95%thought TB was not serious,21.05%thought they were not sick,19.74%thought they were too old to travel,17.11%thought it was too far to travel to the hospital,5.26%were too busy to work,and the number of patients willing to accept free sputum smear Logistic regression analysis showed that those who thought that diabetic patients were more likely to get tuberculosis had a higher degree of willingness to undergo self-pay sputum smear examination,which was 2.428 times higher than those who did not think so.(OR adjusted=2.428,95%CI=1.261 to 4.677).4 Basic situation of township health centers There were 50 township health centers within the three counties surveyed,of which 39 had X-ray machines,with an equipment rate of 78.00%;40(80.00%)had at least one professional radiologist,and 47 township health centers had blood glucose biochemistry testers,with an equipment rate of 94.00%.Among the village doctors managed by the 50 townships investigated,a total of 630 people were responsible for basic public health services,of which 146 village doctors were responsible for health management of diabetic patients,accounting for 9.37%.28,283 diabetic patients were managed by the 50 townships,and each village doctor had to manage 194 patients on average.The majority of village doctors were in the age group of 30-39 years old,with 329 people(52.22%);the shortest working period was 1 year and the longest was 31 years,of which 41.75%of the village doctors had worked for 5-10 years;the majority of education was college,accounting for 46.83%.There were 260 people(41.27%)who did not take the title;there were 327 village doctors who were full-time responsible for basic public health services;260 people(41.27%)had other types of health technicians as job categories.5 Qualitative interviews with village doctors Most of the village doctors were clear about the process of TB symptom screening for diabetic patients,while some of them were vague about the content and process of symptom screening.Most of the village doctors believed that screening for TB symptoms in diabetic patients belonged to the high-risk group of TB,which was conducive to early detection,early diagnosis and early treatment of TB,and could be done more efficiently with the platform of basic public health services.Some village doctors are skeptical about the effectiveness of screening for suspicious symptoms of tuberculosis among diabetic patients.Regarding the problems and difficulties encountered in TB symptom screening:some diabetic patients do not cooperate,the township health centers are understaffed,and some village doctors have not been trained in TB-related knowledge.How to make the screening of tuberculosis symptoms in diabetic patients better:providing training courses related to tuberculosis for village doctors,increasing manpower,giving overtime subsidies to village doctors,and disseminating knowledge related to tuberculosis to diabetic patients.Conclusion:1.It is feasible to use the basic public health service platform to screen diabetic patients for tuberculosis in terms of the willingness of the health service provider(diabetic patients)to receive tuberculosis screening and the ability of the health service provider(primary health care providers)to conduct screening.2.The willingness of diabetic patients to be screened for TB symptoms during outpatient visits or household follow-up visits was high,and the acceptance of screening for symptoms during household follow-up visits was higher.3.The willingness of diabetic patients to undergo TB-related screening when TB symptoms are suspected is high,and it is more likely to be accepted by patients if the screening is free of charge.4.Most primary health care providers have the ability to perform TB-related tests.5.Primary health care technicians are highly motivated to treat tuberculosis screening for diabetic patients,but there is a lack of manpower and relevant knowledge. |
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