DOTS Management Institution And Impact Facters Of TB Patients In China's Rural Areas

ObjectiveLearn about the present situation of DOTS strategy implementation from 12 counties of 6 provinces in China,then assess the quality of DOTS strategy implementation and analyze the possible factors that influence the DOTS strategy from demanders side,and then provide policy recommendations.Method and contentThe study was carried out in six provinces from east,middle and west part,including Jiangsu,Guangdong,Jiangxi.Hubei,Shanxi and Sichuan province.From the demanders side,using qualitative and quantitative research methods to describe and assess the present situation of DOTS strategy implementation,and then analysis the possible influence factors.1.Select TB patients who had been registrated in TB dispensary in 12 counties or districts,using the self-designed questionnaire about TB patients to investigate the whole situation of disease outbreak and treatment.And using multivariable regression method to analysis the impact factors about health seeking delay and diagnosis delay of TB patients.2.Apply individual in-depth interview,focus group discussion and so on to hold the discussion in related personnel including the lead of county and township,TB dispensary, township hospital and TB patients.Result1.DetectionOur country constitute the guide line of patients detection,according to the population of various regions and prevalence of TB.It's constituted gradually.But it reflected some problems about omitting and falseness.2.Detection wayIt's mainly through the refer by county,township and village medical institutions.The proportion of seeking TB dispensary for help actively is fairly low.The known and trust to TB dispensary in farmers is not enough.3.Delay in diagnosis In this study,we use 'health seeking' delay to refer to a period of longer than three weeks from the onset of symptoms to the first visit to a health facility.'Confirmed diagnosis delay' refers to period of more than two weeks from first health seeking activity to confirmed diagnosis.Nearly 16.8%TB patients had health seeking delay,34.3%TB patients has Confirmed diagnosis delay.Many patients experienced several times visits before confirmed diagnosis,the median was 2,5.3-20.4%patients had more than 6 times visits.Medical institution of first seeking,result of first diagnosis and visiting times before confirmed diagnosis impact confirmed diagnosis delay.4.Adherence to treatmentFew TB patients had delayed in treatment,because the patients in this study were all those registered in TB dispensary.Adherence to treatment was good,less thank 15.1% patients has missing or interrupted taking medicine.About the whole patients reported be practised DOT,some distict were primary practicing DOT by doctors,some were primary by family members.But from the patients attitude about visiting medication,14.4% patients consider that taking medicine should need village doctors.,most patients claimed taking medicine by themselves and family members.This datum directly suggest patients attitude about direct observed supervisal,it's worth reference in drafting the direct observed supervisal by medical staff.5.Medical expenditureOur country provide free diagnosis and treatment for TB patients,but because of much additional expenditure of medical institutions,the health expenditure from community perception was fairly high.Beside high direct cost about additional examination,drugs and so on,there were some amount of indirect cost and the cost prior to diagnosis.6.CognitionGovernments and professional institutions make great efforts in health education,but patients' poor self-judgement to suspect symptoms and unknown about tuberculosis,the awareness of free treatment policy and the key measures about cure tuberculosis were still need improvement.The patients' information were mainly from medical staff,the role of modern media is still weak.Suggestion1.Exertion the role of all kinds of medical institutions fully in patients detection,and strengthen the referral systerm of tuberculosis is the key point to increase the rate of patients detection.2.Strengthen the management of medical institutions,reduce unnecessary examination and treatment,fulfill incentive measures,avoid bad behavior of medical staff pursue individual income.Rationale use of project fund,provide more free services,such as reducing fare and supporting poor families.Strengthen and improve new rural cooperative medical system,compensate patients' cost.3.The concrete requirement of doctors'directed observation of taking medicine should according to actual situation of different regions,service radius of health institutions, traffic conditions,health service network and so on.Exertion the role of family supervise and phone supervise.4.Developing a long term work-plan for health education and health promotion,and monitoring the progress regularly to improve public knowledge and attitude.