关键词: 结核, 传染病控制, 医师诊疗模式, 卫生服务研究, 数据说明, 统计, 对比研究

Abstract:

Objective To analyze effectiveness of different models of tuberculosis prevention and control service system in Shanghai and Shenzhen, and to provide reference for improving the construction of tuberculosis service system in China.Methods Shanghai (the representative city of the “Trinity” prevention and control model in 2017) and Shenzhen (the representative city of the “integration of prevention, treatment and management” under the chronic disease prevention and control system in 2017) were selected as the study subjects. The population composition, funding for tuberculosis control, and incidence and registration rate of tuberculosis were collected from “Disease Reporting Information System” and “Tuberculosis Information Management System”, the sub-category of “China Information System for Disease Control and Prevention”. The effectiveness of the two models in patient discovery were evaluated by the four comparable core indexes of “13th Five-Year” tuberculosis prevention and control in national tuberculosis surveillance information, e.g. Overall arrival rate of pulmonary tuberculosis, pathogenic positive rate of pulmonary tuberculosis, screening rate of close contacts of smear-positive pulmonary tuberculosis patients, and drug resistance screening rate in high-risk population.Results In 2017, the floating population of Shanghai and Shenzhen accounted for 40.22% (972.69/2418.33) and 65.30% (818.11/1252.83) of the resident population. The per capita funding for tuberculosis prevention and control was 1.30 yuan (3134.80/2418.33) in Shanghai and 2.89 yuan (3614.90/1252.83) in Shenzhen. The reported incidence of tuberculosis was 26.56/100000 (6424/24183300) in Shanghai and 52.58/100000 (6587/12528300) in Shenzhen. The registration rate of tuberculosis was 27.93/100000 (6754/24183300) in Shanghai and 43.64/100000 (5467/12528300) in Shenzhen. The drug resistance screening rate in high-risk population (68.60%, 319/465), pathogenic positive rate (50.94%, 3269/6417), and close contact screening rate (99.85%, 5403/5411) in Shanghai were lower than those in Shenzhen (82.16% (221/269), 53.70% (2936/5467) and 100.00% (5455/5455)) (χ ²=16.101, P=0.000; χ ²=9.021, P=0.003; χ ²=8.071, P=0.004). Despite differences between the two cities, both cities achieved the task of the “13th Five-Year National Tuberculosis Prevention and Control Plan” with the overall arrival rate of 95%, close contact screening rate of 95%, pathogen positive rate of 50% and drug resistance screening rate in high-risk population of 95%.Conclusion Although the two different tuberculosis prevention and control service system models showed different effectiveness, both achieved the national tuberculosis prevention and control task, indicating that gradually developing and improving the tuberculosis service system according to local conditions is the key of tuberculosis prevention and control.

Key words: Tuberculosis, Communicable disease control, Physician’s practice patterns, Health services research, Data interpretation, statistical, Comparative study