Patient and health care system delays in the start of tuberculosis treatment in Norway.
Patient and health care system delays in the start of tuberculosis treatment in Norway.
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DOI：
10.1186/1471-2334-6-33
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发表时间：
2006-02-24
影响因子：
3.7
通讯作者：
Bjune G
中科院分区：
文献类型：
--
作者：
Farah MG;Rygh JH;Steen TW;Selmer R;Heldal E;Bjune G
结核病治疗的延迟在个人一级增加了发病率和死亡率，在社区一级通过增加传播风险产生了影响。这项研究的目的是评估挪威奥斯陆/阿克舒斯地区结核病患者开始治疗的延迟，并分析造成延迟的风险因素。这项研究基于国家结核病登记处的信息、医院的临床病例说明和初级卫生保健提供者的转诊病例说明。延误分为病人延误、医疗系统延误和完全延误。用多元线性回归分析其与性别、出生地、发病部位、年龄组的关系。在这项研究中纳入的83名结核病患者中，71人(86%)出生在国外。患者、卫生保健系统和总延误的中位数分别为28天、33天和63天，范围为1-434天。在未调整的分析中，根据出生地或年龄组，患者延迟和医疗系统延迟在男性和女性之间没有显著差异。与肺结核病患者相比，肺外结核病患者的病人、医疗保健系统和总延误时间明显更长。两组患者的中位总延迟时间分别为81天和56天。对于出生在挪威的人来说，医疗保健系统的延迟超过了患者的延迟。在调整多个协变量后，60岁以上年龄组的患者延迟时间明显短于15-29岁的参照组。此外，在多变量分析中，出生在挪威的患者比出生在国外的患者有明显更长的医疗保健系统延迟。很高比例的患者在开始结核病治疗时完全延迟了两个月以上。这项研究强调需要在普通人群和卫生人员中提高对结核病的认识。肺外结核病应被视为未解决病例的鉴别诊断，特别是对来自结核病高发国家的移民。
Delay in start of tuberculosis (TB) treatment has an impact at both the individual level, by increasing the risk of morbidity and mortality, and at the community level, by increasing the risk of transmission. The aims of this study were to assess the delays in the start of treatment for TB patients in Oslo/Akershus region, Norway and to analyze risk factors for the delays. This study was based on information from the National TB Registry, clinical case notes from hospitals and referral case notes from primary health care providers. Delays were divided into patient, health care system and total delays. The association with sex, birthplace, site of the disease and age group was analyzed by multiple linear regression. Among the 83 TB patients included in this study, 71 (86%) were born abroad. The median patient, health care system and total delays were 28, 33 and 63 days respectively, with a range of 1–434 days. In unadjusted analysis, patient delay and health care system delay did not vary significantly between men and women, according to birthplace or age group. Patients with extra-pulmonary TB had a significantly longer patient, health care system and total delay compared to patients with pulmonary TB. Median total delay was 81 and 56 days in the two groups of TB patients respectively. The health care system delay exceeded the patient delay for those born in Norway. The age group 60+ years had significantly shorter patient delay than the reference group aged 15–29 years when adjusted for multiple covariates. Also, in the multivariate analysis patients born in Norway had significantly longer health care system delay than patients born abroad. A high proportion of patients had total delays in start of TB treatment exceeding two months. This study emphasizes the need of awareness of TB in the general population and among health personnel. Extra-pulmonary TB should be considered as a differential diagnosis in unresolved cases, especially for immigrants from high TB prevalence countries.