Evaluation Study On Effectiveness Of Implementation Of Village Doctor-Based Rural Health Integration In Improving Tuberculosis Case Detection In Shandong Province

BackgroundAt present, most counties are carrying out or implementing the reform on rural health integration in Shandong Province. The village clinics’operation and management are belonged to the township health center. By implementing rural health integration, rural health resources are planned and allocated reasonably, the service delivery is standardized, the service ability is improved, the new rural cooperative medical care system is strengthened and improved, rural medical and sanitation undertakings are developing rapidly, the rural inhabitants’medical and health needs are satisfied.China is the one of the22highest TB burden in the world. About1310000tuberculosis cases are detected every year in our country, rank only second to India in the world. The core content of TB control is discovery and cure the source of infection. Recommend based on symptoms is the important way of discovering TB patients through rural health organization. Rural health institutions are the bottom of the anti-tuberculosis network that is consisted of province, city, county, township and village, playing crucial role in tuberculosis control, assuming the work of tuberculosis suspects discovering, recommending, referring and tuberculosis patients management. The rural health integration provides opportunity for increasing TB patients found through rural doctors recommending. ObjectivesTo evaluate the effect of the TB cases detection resulting from the rural health integration by analysing the impacts on the way of rural tuberculosis patients’discovery, diagnosis delay and treatment delay based on the intervention measures.MethodsResearch counties were divided into intervention group and control group. Some intervention measures were implemented in the intervention group. The data is getting from the questionnaires of TB patients seeking medical service pattern, routine reports and first visits register of county TB organizations before and after the project in research counties. Epidata3.1was used to establish the database and SPSS17.0was used to analyze the data. Use the chi-square test to compare the constituent ratios. Use the rank-sum test to analyze the patient delay, diagnosis delay and treatment delay of the TB patients.Main Results1. After the intervention, the rate of patients initiatively visited due to symptoms dropped from83.2%to51.1%. The rate of patients referred by township health center increased from2.0%to15.6%in intervention group counties. The differences of constituent ratios of TB suspects before and after the intervention are statistically significant.2. The distribution of the suspect patients’symptoms in intervention counties is different to that in the control counties. In the intervention counties, the rate of the suspect patients whose cough last3weeks or longer is increasing from33.3%before intervention to41.4%, while the rate of the suspect patients whose cough last shorter than3weeks is decreasing from45.7%to37.4%. The differences of the distribution of the suspect patients’symptoms in intervention counties before and after intervention are statistically significant. 3. In the intervention counties, the rate of the diagnosed TB patients in the suspects is increasing from19.5%before intervention to24.0%, while the rate of the non-TB patients in the suspects is decreasing from80.4%to75.9%. The differences of the diagnosis results in intervention counties before and after intervention are statistically significant.4. After the intervention, the number of active TB patients registered in TB prevent institutions in the intervention group counties rises6.1%, while the number falls by8.9%in the control group counties.5. The initial visit delay, the diagnosis delay and the treatment delay after the intervention in the test counties are shorter than them before intervention.Conclusion and Suggestions1. The composition of the suspects’source is changed after the intervention, the rate of the suspects who are recommended by the village doctor after intervention is higher than it before. The effect of village doctors’ recommendation in TB detection is enhanced.2. The implementation of interventions relying on village doctor-based rural health integration can improve TB case detection.3. In the intervention counties, the rate of the diagnosed TB patients in the suspects is increasing, while the rate of the non-TB patients in the suspects is decreasing, suggesting the intervention enhancing the efficiency in TB detection, letting more patients get timely and standard treatment and excusing TB patients’unnecessary medical service seeking process, resulting in the saving of the limited medical resources.4. In the intervention counties, the quality of the TB patients’detection is enhanced after the intervention, the initial visit delay, the diagnosis delay and the treatment delay after the intervention in the test counties are shortening. The implementation of the rural health integration improve the effect of the screening, let TB patients get rapid diagnosis and treatment and control the spread of the TB, so resulting in the decreasing the burden of the non-TB patients and avoiding the waste of the medical resources.