Study On The Effects Of Different Cooperation Approaches Between Health Providers And TB Dispensaries In TB Control

BackgroudTuberculosis is an infectious disease causing serious damage to people health, being as one of key diseases that China government wants to control. Currently, problems such as floating populations, multi-drugs resistance tuberculosis, tubercule bacilus and Human immunodeficiency virus mixed infection are the three challenges to tuberculosis control. China is one of the 22 countries with high tuberculosis burden, rank only second to India.Right now, the Directly Observed Treatment short-term System proposed by World Health Organization is the best methods of tuberculosis control, having made great progresses in TB control. Although all fields covered by DOTS have made obvious achievements, there are many barriers constraining TB control in many countries, one of these barriers is that provides of health services, especially private providers are not enough involved in TB control.According to the factor that mentioned in last section, through the discuss of partners who take part in TB control, formulated the TB control strategy, whose purpose is achieving,the international development targets about tuberculosis mentioned in United Nations millennium proclamation:70%TB detection and 85% success treatment, this strategy was pushed globally in march 17th 2006. One of the six factors included in the TB control strategy is that engaging all health care providers in tuberculosis control, also be called health providers'collaboration with tuberculosis control dispensaries (coorperation between health providers and TB dispensaries).The aims of coorperation between health providers and TB dispensaries that proposed by WHO are to enhance the accessibilities of qualified health services, the TB detection rate, the adherence and decrease patients'burden. On abroad, private hospitals are popular, so the studies on providers-dispensaries cooperation focus on the effect on the patients'behaviors and disease burden after the cooperation between private providers and dispensaries. According to the specific situation of our country, formulating two common coorperation approaches in TB control, one cooperation that between general hospitals and dispensaries(TB dispensaries are responsible for the diagnosis and treatment of TB patients, short for CDC approach), the another cooperation that between designated hospitals and dispensaries(the designated hospitals are responsible for the diagnosis and treatment of TB patients,short for designated hospital approach), but our studies focus on the enhancement of TB detection and success treatment after the cooperation between general hospitals and dispensaries,there is no study focusing on comprehensive evaluation of the effect of our common coorperation between Health providers and TB dispensaries approaches (CDC approache and designated hospital approach).Study ObjectiveThe objective of this study is evaluate the two kinds of providers-dispensaries cooperation approaches through analyzing the situation of the structures of the two kinds of providers-dispensaries cooperation, evulating the effect of the specific responsibilities of the providers that evolved in the cooperation and the effect, comparing the patients behaviors and disease burden under different approaches, to supply secientical basement for TB control stratedies.Study Methodology This study was conducted in the views of the structures of coorpration and effect, using quantitative and qualitative analysis methods. According to the coorperation approaches and economic levels, we chose Zhejiang Dongyang, Shanghai Changing, Guangxi Pingxiang and Guangxi Naning as the study fields. We selected the new patients who have finished treatment in one year before our field study from the patients registration books, so we investigate 203patients in order to analyze the basic situation, seeking health service behaviors, disease burden of TB patients, and review the medicine report of the patients in order to nanlyze the check and drugs during TB patients'outhospiatal and inhospiatal treatment, also we interview the leaders of TB dispensaries, the doctors of county general hospitals, the doctors of TB dispensaries, the deans who are responsible on TB control of designated hospitals, the doctors of township health centers, et.cl. The aims of interview are to know the situation of coorperation appraoaches and their opinion on coorperation approaches.The information of this study was from the reviews of literature, facility investigation, patient face to face investigation, interviews of key people. Field information was collected by the graduates of center for health management and policy Shandong University. Using SPSS software to analyze the quantitative information, mostly make use of descriptive statistics analysis, one factor statistics analysis, using induction description to analyze the qualitative information.Study Results1. The difference of organizational structures of the two kinds of coorperation approaches is whether the TB dispensaries are responsible for the diagnosisi and treantment of TB patients,TB dispensaries are responsible for the diagnosisi and treantment of TB patients underCDC approach, designated hositals are responsible for the diagnosisi and treantment of TB patients under designated hospital approach, bute the village doctors'involvment in TB control is not enough under these two coorperaiton approaches.2. The effects of health providers'specific responsibilities under designated hospital approach are better than them under CDC approach, especially the transfer, trace, patients'management from village doctoes, regular treatment.60%TB patiens were tansfered by provider after first facilities under disignated hospital approach, while this rate is 47%under CDC approach. The trace success rate is 74% under designated hospial approach, while this rate is 64%under CDC approach. The hospitalization rate under CDC approach is higher than that under designated hospital approach, are 39%and 14.6%respectively. About 60%TB patients got management from village doctor under designated hospital approach while this rate is only 6%under CDC approach. The common problems under the two approaches are the low of transfer success and trace success, the few times of management and the prolonging of treatment time, using the unessential examination and second-line anti-tuberculosis drugs.3. The numbers of facilities to which patients seeking health care under CDC approach is larger than that under designated hospital approach, the rate of seeking health services to TB dispensaries and designated hospitals are low, the mean number of facilities under CDC approach is 2.6, this is 2.2 under designated hospital approach, The mean diagnosis delay, treatment delay and total delay under CDC approach are35,12,76 days respectively, under designated hospital approach they! are 11,2,36days.4. The expenditure after diagnosis under CDC model was higher than that under designated hospital model, but the expenditure after regular treatment under designated hospital model was higher than that under CDC model, the mean expenditure after diagnosis and before regular treatment under the two coorperation aproaches are RMB2416,252 respectively, the mean expenditure after regular treatment under the two coorperation aproaches are RMB1679,2203 respectively. Hospitalization rate is higher under CDC approach than that under designated hospital approach, although the average inhospital days of inhospital TB patients are 22days, the average expenditure of inhospital TB patients under CDC approach is higher than that under designated hospital approach, are RMB7785, 5307 respectively. Conclusions and SuggestionsSo we can see that, the organization structure under designated hospital appraoch is more rational than that under CDC approach, the effect of specific responsibilities of providers evolved in cooperation, patients'behaviors and disease burden under desiganted hospital approach is better than them under CDC approach, meanwhile, there are many provinces trying to push the designated hospital model, potential suggestions are:1. Put centralized management by specialized department in more practice, the health bureau must publish the rules on centralized management by specialized department and made corresponding rewards and punishments, the guidelines on TB diagnosis and treatment, strengthen the training of TB workers.2. Commencing the designated hospital model, it can avoid the problems such as the public health mission of CDC is not defined et.cl. Through the cooperation between general hospitals and dispensaries, we can tap their advantage, integrate resources and enhance the effect in TB control.3. Strengthen the education that related to TB and TB control strategies.Enhancing the level of TB knowledge and alert of health workers, especially the primary health workers in order to transfer patients.4.; Evolving the expenditures of TB diagnosis and treatment in the range of local medical insurance, enhancing the reimbursement rate step by step and it is helpful to decrease patients'burden, enhancing the adherence and reduce the risk of multi-drugs resistance tuberculosis.