摘要
目的探索影响结核病患者社会确认的关键因素,完善患者管控政策,以减少疾病延迟和患者就医辗转。方法选取湖北省肺结核定点医院27名住院患者进行深入访谈,结合扎根理论,采用NVivo 11 Plus软件对患者社会确认感知及影响因素进行框架构建。结果肺结核患者社会确认路径主要分为因症就诊、筛查和健康体检3种,其中因症就诊占比85%以上;社会确认的影响因素包含患者因素、卫生系统因素、环境因素和疾病因素4个方面,其中患者的健康认知和健康行为、疑似患者跟踪管理与管控效果密切相关;辗转就诊的频次在确诊延误程度上差异有统计学意义(P<0.001),就医辗转是导致社会确认延误的重要危险因素。结论由于肺结核症状特征和诊断要求具有特殊性,相较于因症就诊,健康体检和筛查是降低疾病延迟风险的推荐策略。建议完善结核病定点管理制度、加强落实医疗机构转诊制度、强化综合医院的结核防控职能、适当扩大肺结核高危人群的筛查范围。
Objective Explore the key factors affecting the social verification of the pulmonary tuberculosis patients and improve patient control policies in order to reduce the time delays and repeated medical visits in care seeking for sufferers.Methods A series of in-depth interviews were conducted among 27 inpatients of pulmonary tuberculosis served by Wuhan Pulmonary Hospital.Combined with the Grounded Theory,the statistical analysis was performed using the software NVivo 11 Plus to set the framework of patients'perception of social verification and influencing factors.Results The social verification pathway for pulmonary tuberculosis patients includes visiting a doctor due to illness,disease screening and physical examination,where visiting a doctor due to illness accounts for more than 85%.The key influencing factors include patient,medical system,living environment and sickness factors among which the patients'health cognition,health behavior,and the tracking management of suspected patients are closely related to the control effect.Repeated medical visiting is statistically significant(P<0.001),which is an important risk factor for verification delay.Conclusion Compared with visiting a doctor due to illness,disease screening and physical examination are better options to reduce the risk of time delays and repeated medical visits in care seeking,because there are some specifieness in the pulmonary tuberculosis symptom and diagnosis process.It is suggested to improve the designated tuberculosis management system,enforce the referral system for medical institutions,strengthen the tuberculosis prevention and control functions of general hospitals in the future and to appropriately expand the disease screening range for people with high risk of tuberculosis.
作者
张研
吴旨晴
张娜
李月华
Zhang Yan;Wu Zhiqing;Zhang Na;Li Yuehua(Huazhong University of Science and Technology School of Medical Management/The Huake Base of the National Institute of Medical Security,Wuhan,Hubei,430000,China;不详)
出处
《中国医院管理》
北大核心
2023年第5期49-53,共5页
Chinese Hospital Management
基金
国家自然科学基金面上项目(71974064)
武汉市卫生健康科研基金(WG18D02)。
关键词
肺结核
社会确认
路径分析
pulmonary tuberculosis
social verification
pathway analysis
