对社区流动人口结核病管理的循证评价

摘要

目的 调查分析社区流动人口结核病管理和治疗措施,并对其进行系统评价,考察结核病控制管理的效果,为专门针对流动人口制定科学可行的干预方案,亦为进一步探索和更新流动人口结核病管治策略提供可靠依据.方法 计算机检索中国医院数字图书馆、万方医学网及中国知网等数据库和手工检索有关医学期刊、专著;纳入1998-2010年发表的关于流动人口结核病治疗、管理、护理干预的文献;同时采用非概率目的 性抽样方法,在获得访谈对象知情同意后进行现场访谈.结果 共检索列符合纳入标准的已发表文献137篇,通过查看全文.最后评价为1级证据9篇,2～3级15篇.从纳入评价的文献及访谈结果显示:运用符种有效的管理措施包括健康促进、提供激励机制、跨区域转诊追踪、对病人实行DOTS管理等,均取得一定的效果;但流动人口对结核病相关知识和免费治疗政策了解有限,看法不一,结核病防治的意识较差,居住不稳定,缺乏有效的联系方式,致使对流动人口的追踪督导困难,流动结核病人的管理哌待加强.结论 有必要对流动病人扩大免费治疗及相应的费用补贴,开展全方位、多形式的社区防痨知识及国家对结核病控制政策的宣传,加强社区结核病督导的力度,开展个体化循环互动式的健康教育,提高结核病人遵医的依从性.%Objective To investigate management and treatment to tuberculosis(TB)of floating population in the community,and evaluate systematically,study the effect of TB control management,in order to provide reliable basis for developing the scientific and practical intervention programs specifically for the floating population,and also to further explore and update the governance strategy of the floating population of TB.Hethods The databases of CHKD,WANFANG MED ONLING and CNKI Etc,were searched and analyzed by computer,and related medical journals and monographs were studied by manual searching,getting the issued literature on the treatment,management,nursing intervention of floating population tuberculosis from 1998 to 2010.At the same time we used non-probability purposive sampling method and had on-site interviews after obtaining the interviewee informed of consent.Besults We retrieyed 137 documents that have been published meeting the inclusion criteria,by viewing the full text,9 docunents had been evaluated for the 1 evidence and 15 documents had been evaluated for the 2～3 finally.From the literature with the evaluation and interviews.it showed that:to use a variety ofeffective management measures include health promotion,providing incentives,cross-regional referral tracking,DOTS nanagemerit of patient,had achieved certain effects.But the floating population understood limitedly TB-related knowledge and free treatment policy and had mixed views,that the awareness of TB control is poor,residential instability,lack of effective contact,resulted in difficuhing in supervision and tracking of the floating population.The TB management to floating population patients should be strengthened.Condusion It is necessary to expand the free flow of patient treatment and the corresponding cost of subsidies,to carry out comprehensive and multi-fornKq of community knowledge on TB and the publicity on national TB control policy,to make efforts to improve community supervision OfTB,and carry out individual recycling interactive health education for improving the compliance of TB patient.