教育宣传促进初级保健中结核查:一个集群随机对照试验
Chris Griffiths1, Pat Sturdy2, Penny Brewin3
1Centre for Health Sciences, Barts and The London, Queen Mary's School of Medicine and Dentistry, London, UK; Lower Clapton Group Practice, Lower Clapton Road, Hackney, UK; MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London School of Medicine, Guy's Hospital, St. Thomas' Street, London SE1 9RT, UK.
英国的一项初级保健外展计划显著改善了结核病查,从而更好地识别了活跃和潜伏的结核病例,并增加了BCG疫苗接种范围. 这凸显了工业化国家中这种举措的价值.
科学领域:
- 公共卫生 公共卫生
- 传染病控制和控制传染病
- 初级医疗保健医学 一级医疗保健医学
背景情况:
- 结核病 (TB) 是工业化国家日益严重的公共卫生问题.
- 目前针对结核病的公共卫生控制策略的有效性仍然不确定.
- 需要评估初级保健机构结核病查的新方法.
研究的目的:
- 评估一项旨在加强英国初级保健区内结核病查的计划.
- 确定外展计划对识别活跃和潜伏结核病例的影响.
- 为了评估BCG疫苗接种覆盖率的变化,作为干预的结果.
主要方法:
- 一个集群随机对照试验,涉及伦敦哈克尼50家全科医院.
- 干预组接受了一项宣传计划,促进结核病查;对照组接受了通常的护理.
- 查包括口头评估和结核素皮肤测试;主要结局是初级保健中发现的活跃结核病例.
主要成果:
- 与控制实践相比,干预实践中的结核病查率 (57%) 显著更高 (0.4%).
- 在干预实践中增加了活跃结核病例的诊断 (47%对34%,OR 1.68,p=0.03).
- 潜在结核病诊断增加的趋势 (19%与9%,p=0.055) 和显著更高的BCG覆盖率 (比率比率9.52,p<0.001).
结论:
- 教育干预有效地改善了活跃和潜伏结核病的识别.
- 该计划导致BCG疫苗接种率大幅增加.
- 初级保健查计划应被视为发达国家结核病控制战略的组成部分.
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