The Analysis And Evaluation Of The Current Situation Of Implementation Of The Cooperation Of General Hospitals And Tuberculosis Dispensaries Strategy On Tuberculosis Control In The City Of Wuhan

ObjectivesTo study the implementation module and method of the cooperation of general hospitals and tuberculosis(TB) dispensaries strategy in Wuhan; analyze the strengthens and shortcomings of both the traditional tuberculosis control module and new cooperation of general hospitals and TB dispensaries module,and the functions of general hospitals,TB dispensaries,TB special hospitals,the community health service organizations,the assigned hospital for tuberculosis control in the new one; evaluate the effectiveness of the implementation of the cooperation of general hospitals and TB dispensaries strategy on tuberculosis control so as to provide feasible suggestions for enhancing the performances of the tuberculosis control and making the work sustainable.MethodsThis study used the research methods of empirical study and policy analysis and based on qualitative and quantitative analysis to provide a description and evaluation of the module and effectiveness of the implementation of the cooperation of general hospitals and TB dispensaries strategy. The crucial links and routes of the cooperation of general hospitals and TB dispensaries are discussed with the help of the analysis of the current situation on TB control in order to provide suggestions to improve the module of the cooperation of general hospitals and TB dispensaries strategy.1. Have interviews with relevant supervisors, medical personnel concerned with TB control by using methods of focus group discussion and in-depth interview;.2. Collect reports on TB control and relevent files from TB dispensaries.Results1. Achivements and Characteristic of the Cooperation of General Hospitals and TB Dispensaries(1) Through the implementation of the cooperation of general hospitals and TB dispensaries strategy, a three-level TB control network which is formed by district-level centers for disease control—general hospitals,community health service centers,township hospitals—community health service stations,village clinics.(2) The pattern of general hospitals reporting through internet-based communicable diseases reporting system, referring tuberculosis patients and TB dispensaries tracing tuberculosis patients has been set up. The work of registration,epidemic report,referring TB patients in general hospitals has been improved. The rates of epidemic report,referring TB cases from general hospitals to TB dispensaries are both 98.9% and it has meet the requirements.(3) Some new modules of cooperation of general hospitals and TB dispensaries are explored such as the establishment of"preventive diagnosis and treatment system on TB control". In the system TB special hospitals,assigned hospital for tuberculosis are the centralized organizations for diagnosing and treating tuberculosis cases. The effectiveness of these modules are good.(4) Community-based Directly Observed Treatment Short-cours (DOTS) have been carried out and improved in all the communities and towns in Wuhan. With the joint effects of district-level TB dispensaries and public health department in community health service centers and township hospitals, the quality of Cmmunity-based DOTS have been increased further. (5) The TB cases treatment and management information network is developped and perfected with an extension to community longitudinally and a connection to the hospital information system of TB special hospitals.(6) The five rates about TB control has met the requirements of tuberculosis control programme of our country. The performance of TB control in Wuhan are among the top of the whole country.(7) A set of incentive and compensation systems which are aiming at rewarding the staffs in hospitals who report through internet-based communicable diseases reporting system and refer TB cases who arrived from general hospitals to TB dispensaries, offering subsidy to community doctors for DOTS and compensating assigned hospital for tuberculosis have been established(8) Because of the TB control funds being allocated reasonably and the free policy about TB diagnosis and treatment being fully fulfilled, the quality of TB control has been improved.2. Problems and Deficiencies of the Cooperation of General Hospitals and TB Dispensaries(1) The work of TB control in general hospitals still need be strengthened while the functions of general hospitals and TB dispensaries are not clear and there lacks of an effective communication system between them. The registration rate of TB cases is only 39.1% and the incompletion of patients'information is common. There phenomenons of missing and delaying reporting,refering TB cases still existi n some general hospitals.(2) The layout of DOTS room in many community health services cannot satisfy the requirements of nosocomial infection. Being in charge of various tasks, the staffs who execute DOTS are hard to ensure the high quality of the TB control job. And it is found that the DOTS for MDR-TB cases do not meet standards in some communities.(3) The managerial issues in TB special hospitals become noticeable. The coverage rate of the free policy and the actual referring rate both need to be increased.(4) Residents have a little knowledge of and trust in the TB dispensaries and this phenomenon has a negative impact on the work of TB control. Conclusions(1) The three-level TB control network has been set up through the implementation of the cooperation of general hospitals and TB dispensaries strategy.(2) The finding level of tuberculosis patients has been increased with the help of the pattern of referring and tracing tuberculosis patients.(3) The effectiveness of the new modules of cooperation of general hospitals and TB dispensaries are good. But there are some problems need to be improved.(4) The quality of TB control work in community health service organizations and township hospitals has been increased. But the construction of the room for DOTS need be strengthed.(5) The TB cases treatment and management information network developped well.(6) The quality of TB control work in general hospitals has been also improved.The rates of epidemic report,referring TB cases from general hospitals to TB dispensaries both meet the requirements. But the registration of TB patients need be strengthed.Suggestions(1) It should continue to improve the work of TB control in general hospitals and increase the staffs'awareness of participating in the work of TB control legally by strengthening training. Enhance the communication between general hospitals and TB dispensaries and ameliorate managerial conditions of convergence case in some general hospitals in suburb areas.(2) Focus on the resolution of managerial problems in TB special hospitals, gradually address the issue of low rates of both referring TB cases and referring TB cases who actually arrived by further enhancing the connection of TB dispensaries and TB special hospitals.(3) Improve the work of TB control in community health organizations. Guarantee the quantity of the staffs engaged in the work of TB control in communities or country and ameliorate the construction quality of DOTS room.(4) Promote the module of the assigned hospital undertaking diagnosis and treatment TB cases so as to solve the problems of the difficult cooperation between TB dispensaries and general hospitals and the low rate of referring TB cases who actually arrived.(5) Emphasize on the construction of TB dispensaries with the objective to accord with the current situation of TB control.(6) Combinethe work of TB control with the medical reform in order to bring the cost of diagnosis and treatment for TB into the medical security system. Further improve the level of detectment of TB cases with the effective engagement of medical security system.(7) Continue to strengthen training so as to enhance the staffs'awareness of the importance of TB control and skills conducting relevant work.