摘要
目的调查江苏省农村结核病控制示范项目县和新项目县慢性咳嗽患者的就医行为和医疗费用,探讨影响结核病医疗服务可及性的因素。方法对连续3周内在建湖县(项目县)和阜宁县(新项目县)县综合医院就诊的291例咳嗽2周以上的患者进行调查表询问,利用因子分析获得研究对象经济学评分并均分为4组,并用单因素和多因素方法对研究对象的就医行为、医疗费用和接受的医疗处置(转诊、痰检)进行分析。结果咳嗽患者在症状出现2周后仍有36%人次选择村诊所就诊。在综合医院就诊的患者中有6例被转诊至县结防所,8例接受痰涂片检查。经济状况是影响慢性咳嗽患者选择首次就诊医疗机构的主要因素(P=0.036)。所在县别与所支付的交通食宿费用(r=-0.58,P=0.005),医疗费用(r=-0.38,P=0.023)和总费用(r=-0.54,P=0.005)显著相关,公费患者支付的总费用低于自费患者(r=0.35,P=0.046)。结论加强农村人群中的结核病患者及时到正规结核病防治机构就医意识,强化综合医院结核患者归口转诊的落实,控制和降低咳嗽患者的医疗费用,对结核病的早期诊断、治疗和疫情控制具有重要意义。
Purpose To investigate the health seeking behaviors and expenditures for chronic cough among outpatients in counties with 10-year National TB Control Program（NTP） and less than 1-year NTP; to analyze factors influencing patient＇s access to tuberculosis （TB） care. Methods Two hundred and ninety-one patients with cough longer than 2 weeks were identified from the county general hospital in Jianhu and Funing county during 3 weeks in a cross-sectional study. Structured questionnaire interviews were carried out for data collection. Factor analysis was used to evaluate the economic status of the object. Univariate and multivariate analysis were applied to quantify health seeking behaviors and expenditures on transportation and medical care among patients with different socioeconomic status. Results Still 36 % of all healthcare visits happened in non-hospitals after cough continues beyond 2 weeks. In the township hospitals and above, only 8 patients received the sputum smear test and 6 got referral to the county TB dispensary. The preference for health facilities differed between patients from different counties（P=0. 010）, so did among patients with different economic status （P = 0. 036）. The per capita expenditure was associated with the counties regardless of expenditures for transportation （r= -0.58, P=0.005）, medical care （r= -0.38, P=0.023） and the total expenditures（r= -0. 54, P = 0. 005）. Besides, patients with medical insurance paid less total expense than those without medical insurance（r = 0.35, P = 0. 046）. Conclusions It is of great importance in TB case detection and TB control to strengthen the health education on TB in rural population, to emphasize the implementation of the convergence management system on TB care, and to cut down patient＇s expenditures on chronic cough medical care.
出处
《复旦学报（医学版）》
CAS
CSCD
北大核心
2006年第1期39-43,共5页
Fudan University Journal of Medical Sciences
基金
UNDP/WORLDBANK/WHO/TDR资助项目(WHO/TDRA10123)
关键词
慢性咳嗽
就医行为
结核病控制项目
chronic cough
health seeking behavior
national tuberculosis control program
