【作者】 楚亚林；

【导师】 肖水源；

【作者基本信息】 中南大学 ， 流行病与卫生统计学， 2011， 硕士

【摘要】 目的：探讨影响贵州省肺结核病人诊治延迟的主要因素,分析病人求医行为及卫生系统服务提供行为,研究病人诊治延迟情况及其影响因素,以期明确贵州省结核病防治过程中存在的主要问题,为更好地做好结核病防控工作、有效实施DOTS策略提科学的依据。方法：(1)研究现场及对象：选择贵州省的平坝县、威宁县、余庆县和遵义县作为本次研究的样本县；研究对象为四个县疾病预防控制中心的门诊及住院病人或县级综合性医院收治的确诊肺结核病人。(2)资料的收集方法：采用自行设计的调查问卷,用访谈式问卷调查法收集资料。(3)资料的分析方法：将所有资料编码后录入SPSS17.0统计软件,对资料进行描述性统计分析、单因素分析及Logistic回归分析等。结果：(1)总体概况：共调查243例肺结核患者,男性148例,女性95例。其中初治病人226例,女性93例,男性133例；复治病人17例,女性2例,男性15例。(2)结核病人的认知情况：60.1%的病人不知道患肺结核应该去当地的结核病防治所,72.8%的病人不知道肺结核正规疗程,86.8%的病人对于结核病能否治愈不清楚。接受健康教育情况：有71.2%的病人从未接受过相关结核病的宣传教育,统计发现文化程度和职业类型在接受健康教育问题上有差异且显著有意义。(3)延迟治疗情况：有99例(40.8%)的肺结核病人(38.5%的男性和44.2%的女性)存在就诊延迟。有34例(14%)的肺结核病人(14.1%的男性和13.7%的女性)存在确诊延迟。治疗延迟病人29例(12.8%的男性和10.5%的女性),占所有调查对象的11.9%。(4)延迟发生的影响因素分析：分别对就诊延迟、确诊延迟、治疗延迟的可能影响因素进行单因素分析和Logistic回归分析。发现影响就诊延迟的主要因素为本地居住时间、是否知晓肺结核症状、是否知晓患病到哪儿看病、社会支持等四个变量。影响确诊延迟的因素为本地居住时间、家庭全年纯收入、是否知晓患病到哪儿看病、肺结核能否治好等四个变量。影响治疗延迟的因素为家庭年纯收入、是否知晓肺结核症状、是否知晓肺结核能治好、是否知晓肺结核的正规治疗疗程、社会支持等五个变量。结论：(1)就诊延迟较高,其次是确诊延迟、治疗延迟。对结核病防治知识、机构和政策等的知晓情况是影响结核病人及时诊治的最主要因素。(2)接受健康教育情况较差,宣传力度不够,宣传方式不灵活,总体效果不好。肺结核病人结核病防治知识知晓率较低。(3)提高肺结核病人的社会支持程度,有利于其诊治及时,有效地遏制结核病的快速蔓延。更多还原

【Abstract】 Objectives:To explore the factors associated with diagnosis and treatment delay for patients with tuberculosis in Guizhou province, analyze the medical seeking behavior of patient and health system’s service providing behavior, study the degree and factors of the delay in tuberculosis diagnosis and treatment. Find out the main problems of TB control process in Guizhou province; provide policy recommendations for how to effectively use DOTS strategy and how to do a better job in TB control.Methods:(1) Research field and objects:choose Pingba, Weining, Yuqing and Zunyi County as the research samples; research objects were TB patients in CDC of those counties and outpatient and inpatient TB people in the county’s comprehensive hospital.(2) Methods of Data collection:use Self-designed questionnaires and in-depth interview to collect data.(3) Methods of Data analysis:coding all data and using SPSS 17.0 statistical software to do descriptive analysis, single factor analysis and Logistic regression analysis.Results:(1) General Overview:totally surveyed 243 TB patients (man 148, woman 95). The first medical consultation patients are 226(man133, woman 93); the retreatment patients are 17(man 15, woman 2). (2) The cognition of TB patients:60.1% patients do not know that they should go to the local TB Prevention and Treatment Institute,72.8% patients don’t know regular process of tuberculosis,86.8% patients don’t know whether TB can be cured. Receive health education:71.2% patients never received the related education; we found that cultural degree and occupational type have differences and significant affected the degree of health education.(3) Delay of treatment:99 (40.8%) tuberculosis patients (man 38.5% and woman 44.2%) have delays in seeing a doctor.34 (14%) tuberculosis patients (man 14.1% and woman 13.7%) have diagnosis delay.29 patients have treatment delay (man 12.8% and woman 10.5%), account for 11.9% of all surveyed patients.(4) Factors influence on the delay:we respectively analyzed the possible influencing factors associated with the delay in seeking medical service, diagnosis and treatment through Single factor analysis and Logistic regression analysis. We found that the main factors that affect the delay in seeking medical service were local living time, whether known tuberculosis symptoms, whether known where to see the doctor, social support. The main factors that influence diagnosis delay were local living time, average annual family income, whether known where to see the doctor, whether known tuberculosis can be cured. The factors affect treatment delay were average annual family income, whether known that tuberculosis symptoms, tuberculosis can be cured, the regular treatment process and subjective support.Conclusions:(1) Incidence of the delay in seeking medical service is much higher than diagnosis and treatment delay. Tuberculosis patients have low knowledge on TB prevention and treatment and related institutes and policies are the main factors impact on TB patients’behavior.(2) TB patients have low cognition on TB prevention and treatment, poor health education and lack of policy dissemination, the overall result is not good.(3) In order to effectively suppress the rapid spread of tuberculosis and make TB patients have timely diagnosis and treatment, the social support for tuberculosis patients should be further developed.更多还原