【摘要】 目的对县级实施新型结核病防治服务体系的优势、劣势、机遇和威胁进行系统分析,为制定相应发展策略提供科学依据。方法分析定点医院活动性肺结核疫情,借鉴社会学定性研究方法,对相关人员个人访谈,并将疫情与访谈资料进行SWOT分析。结果 2013年试点县的新涂阳肺结核患者登记率,试点城区的涂阴患者登记率明显高于全省平均登记率(P<0.05),在实施新型结核病防治服务体系前后3年时间,试点县的肺结核患者的登记情况和治愈率均无明显差异(P>0.05);定点医院解决医疗机构执业问题,加强基层结核病的诊断与治疗队伍;但结核病防治工作涉及到医院与疾病预防控制中心两家单位,医院对公共卫生服务方面精力与意识日益削弱;定点医院已纳入结核病防治服务体系,符合新医改总体目标;防治经费筹资渠道不通畅,未能将结核病防治工作与医药卫生体制改革紧密结合。结论积极稳妥、逐步构建定点医疗机构、基层医疗卫生机构、疾病预防控制机构分工明确、协调配合的防治服务体系;应严格掌握定点医院的准入制度;应完善各项保障措施。更多还原

【Abstract】 Objective To analyze the strengths,weaknesses,opportunities and threats of the new service system of TB prevention and control executed at county level in Fujian province so as to provide scientific basis for the further development of strategy. Methods Data were collected on epidemics of active TB registered in the listed hospitals,and the sociological research method was used to interview relative persons.Then SWOT analysis was used to investigate the epidemic and personal interview data. Results In 2013,the registration rate of new smear positive(P <0.05)and smear negative(P <0.05)pulmonary tuberculosis in the pilot county was significantly higher than the provincial average level.But the registration(P >0.05)and the recovery rate(P >0.05)of TB patients in the pilot county before the new service system of TB prevention and control executed was not significantly different with the 3years after the new system executed.The listed hospitals solved the practice problem of medical institution and strengthened the medical group for the diagnosis and treatment of tuberculosis.TB prevention and control involved both hospital and center for disease control and prevention,but the energy and sense hospital cost in the public health service was being weakened.So the listed hospitals was incorporated into the TB control service system,and that was in line with the overall goal of new medical reform.Financing channel of TB prevention and control was not smooth,not the tuberculosis control work closely with the medical and health system.It couldn’t closely connect TB prevention and control with the reform of the pharmaceutical and healthcare systems. Conclusion To actively,steadily and gradually establish the new service system of TB prevention and control including the listed medical institutions,community medical institutions and centers for disease control and prevention,which have clear task and can cooperate and coordinate with each other,the rules should be implemented strictly on listed hospital access and relative supporting measurements should be improved.更多还原