【摘要】 目的 了解我国西部肺结核高疫情地区主动筛查发现的患者接受治疗的意愿,探索健康教育对纳入治疗率的影响。方法采用横断面研究的方法,于2017年9—12月在全国报告发病率最高的青海、贵州、广西、西藏、新疆5个省(自治区),各选择1个乡镇,对肺结核主动筛查项目中发现的149例肺结核患者,分别于诊断后进行10 min的健康教育,在健康教育干预前后进行面对面访问式问卷调查。问卷内容包括患者个人基本信息、家庭及收入情况、医疗支出情况、前往肺结核定点医院交通方式及费用,以及诊断后即刻、进行10 min健康教育后纳入对象的治疗意愿情况,不愿意接受治疗的原因等。干预前后两次调查均发出149份问卷,收回149份,均为有效问卷,有效率均为100. 00%。分析健康教育前后肺结核患者纳入治疗率的改变情况。采用单因素分析和多因素logistic回归分析对健康教育后影响患者纳入治疗的因素进行统计学分析。结果开展健康教育前,主动发现的肺结核患者纳入治疗率为78. 52%(117/149),10 min健康教育后提高至85. 23%(127/149)。经10 min健康教育后,单因素分析结果显示:与贵州(0,0/39)相比,青海(29. 41%,10/34)、广西(26. 09%,6/23)、新疆(15. 62%,5/32)的患者纳入治疗的意愿较弱(χ~2=18.13, P<0. 001);与<65岁患者(2. 44%, 1/41)相比,≥65岁患者(19.44%,21/108)纳入治疗的意愿较弱(χ~2=6. 83,P=0. 009);与往返定点医院时间≤30 min的患者(8. 43%,7/83)相比,往返时间>30 min的患者(22. 73%, 15/66)纳入治疗的意愿较弱(χ~2=5.97,P=0. 015)。多因素分析结果显示:年龄≥65岁的患者(OR=10.18,95%CI:1.31～79. 38;Waldχ~2=4. 91,P=0. 030)及往返定点医院所需时间>30 min的患者(OR=3. 36,95%CI:1.25～9. 02; Waldχ~2=5. 78,P=0. 020)纳入治疗的意愿较弱。结论健康教育对提高患者纳入治疗率有明显效果,以村医入户方式效果较为明显;应重点关注65岁及以上老年人和往返治疗点时间较长患者的纳入治疗工作。更多还原

【Abstract】 Objective To understand the willingness of anti-tuberculosis treatment and explore the influence of health education on the rate of anti-tuberculosis treatment among tuberculosis cases diagnosed by active finding.Methods Using a cross-sectional study method, 149 cases of tuberculosis patients found in the active screening program for tuberculosis were selected in one of the five provinces(or autonomous regions) with the highest tuberculosis incidence in Qinghai, Guizhou, Guangxi, Tibet, and Xinjiang from September to December in 2017. A10-minute health education was conducted after the diagnosis, and a face-to-face interview questionnaire was conducted before and after the health education intervention. The questionnaire survey included personal basic information,family income, medical expenses, transportation costs to the designated hospital, treatment intention after diagnosis and after ten minutes’ health education, and the reasons not willing to accept treatment. Before and after intervention, 149 questionnaires were both sent out and 149 questionnaires were returned with 149 valid questionnaires. The treatment rate before and after health education were analyzed. Univariate analysis and multivariate logistic regression analysis were used to analyze the factors influencing the treatment willing of patients after health education.Results After health education, the rate of willing to receive treatment was raised from 78. 52%(117/149) to85. 23%(127/149). After 10-minutes health education, the results of univariate analysis showed that compared with Guizhou(0, 0/39), the tuberculosis patients from Qinghai(29.41%, 10/34), Guangxi(26.09%, 6/23) and Xinjiang(15. 62%, 5/32) were more reluctant to be treated(χ~2 = 18. 13, P<0.001). Compared with patients younger than 65 years old(2. 44%, 1/41), patients older than 65 years old(19. 44%, 21/108) had less willing to be treated(χ~2=6. 83, P=0. 009). Compared with patients who had been going back and forth to the designated hospital for less than 30 minutes(8. 43%, 7/83), patients who had been going back and forth for more than 30 minutes(22.73%, 15/66) had a higher rate of unwilling to be treated(χ~2=5. 97, P= 0.015). The multivariate analysis showed that the rates of unwillingness to be treated among cases ≥65 years(OR= 10. 18, 95%CI: 1. 31-79. 38;Wald χ~2=4. 91, P=0. 030) and cases who take more than 30 minutes from home to hospital(OR=3. 36, 95%CI:1.25-9. 02; Wald χ~2 = 5. 78, P=0. 020) were significantly higher. Conclusion Health education can improve the rate of willing to receive treatment. The effect of village doctors’ home education is more obvious. Patients over65 years old and far from designated hospitals should be paid more attention.更多还原